MEDMARK TREATMENT CENTERS OF TEXAS INC NPI 1770781106

NPI Information

NPI: 1770781106
Provider Name: MEDMARK TREATMENT CENTERS OF TEXAS INC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 45D2026179

Address:
5201 MCCART AVE
SUITE H
FORT WORTH, TX
ZIP 76115
Phone: (817) 207-8700
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MEDMARK TREATMENT CENTERS OF TEXAS INC is a rehabilitation and substance use disorder clinic center in Fort Worth, TX. MEDMARK TREATMENT CENTERS OF TEXAS INC NPI is 1770781106. The provider is registered as an organization entity type.

The provider's business location address is:

5201 MCCART AVE
SUITE H
FORT WORTH, TX
ZIP 76115-711
Phone: (817) 207-8700
Fax: (817) 207-8778

The provider's authorized official is Genco D'andria .
The authorized official title is Cfo and has the following contact phone number (214) 379-3300.

The CLIA number assigned to this NPI record is 45D2026179 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/6/2007 and was last updated on 1/12/2021.

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	261QM2800X	Clinic/Center	Methadone	1000027	TEXAS	No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	1000027	TEXAS	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	1000027	OTHER	TEXAS	LICENSE
2	285947202	MEDICAID	TEXAS

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: 11/14/2023

NPI Synchronization or Removal

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