MEDICARE: M A C T HEALTH BOARD, INCORPORATED

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
1	261Q00000X	Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1508724337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M A C T HEALTH BOARD, INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 939
Second Line	:
City	:	ANGELS CAMP
State	:	CA
Zip	:	95222-0939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	367 CREEKSIDE DR
Second Line	:
City	:	BEAR VALLEY
State	:	CA
Zip	:	95223-9455
Country	:	US
Telephone Number	:	209-674-6198
Fax Number	:	209-674-6272

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN SHAWVER ALEXANDER
Credential	:
Telephone Number	:	209-754-6258

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/15/2026

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