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NPI Code Detail

MEDICARE: MEDMARK TREATMENT CENTERS OF ALABAMA, INC.

MEDICARE: MEDMARK TREATMENT CENTERS OF ALABAMA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1114398799
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDMARK TREATMENT CENTERS OF ALABAMA, INC.
Provider Business Mailing Address
First Line : 1720 LAKEPOINTE DR STE 117
Second Line :
City : LEWISVILLE
State : TX
Zip : 75057-6425
Country : US
Telephone Number : 214-379-3300
Fax Number : 214-853-9018
Provider Business Practice Location Address
First Line : 9283 W US 84
Second Line :
City : NEWTON
State : AL
Zip : 36352-8207
Country : US
Telephone Number : 214-379-3300
Fax Number : 214-379-3324
Authorized Official
Title or Position : VP, TREASURER
Name : BRUCE JARVIE
Credential :
Telephone Number : 214-379-3300
Provider Enumeration Date : 10/08/2015
Last Update Date : 07/29/2024

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