MEDMARK TREATMENT CENTERS - FRESNO WEST INC NPI 1568676575

NPI Information

NPI: 1568676575
Provider Name: MEDMARK TREATMENT CENTERS - FRESNO WEST, INC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 05D2029342

Address:
1310 M STREET
FRESNO, CA
ZIP 93721
Phone: (559) 264-2700
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MEDMARK TREATMENT CENTERS - FRESNO WEST, INC is a methadone clinic center in Fresno, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. MEDMARK TREATMENT CENTERS - FRESNO WEST, INC NPI is 1568676575. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1310 M STREET
FRESNO, CA
ZIP 93721-808
Phone: (559) 264-2700
Fax: (559) 264-2767

The provider's authorized official is Michael Saul .
The authorized official title is Vp and has the following contact phone number (214) 379-3300.

The CLIA number assigned to this NPI record is 05D2029342 - other - narcotic treatment ctr with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2007 and was last updated on 2/13/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	173000000X	Legal Medicine		PENDING	CALIFORNIA	No
2	261QM2800X	Clinic/Center	Methadone	10-06	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10-97	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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