Healthcare Provider Details

I. General information

NPI: 1588725196
Provider Name (Legal Business Name): MARK TWAIN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SAWMILL CREEK RD
COPPEROPOLIS CA
95228
US

IV. Provider business mailing address

768 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9707
US

V. Phone/Fax

Practice location:
  • Phone: 209-785-0000
  • Fax: 209-785-7085
Mailing address:
  • Phone: 209-785-7000
  • Fax: 209-785-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number030000058
License Number StateCA

VIII. Authorized Official

Name: NIKKI OCHOA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 209-467-6442