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General NPI Number Information
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NPI Number | 1942362561
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Entity Type | Organization
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Legal Business Name | MARK TWAIN MEDICAL CENTER
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 590 STANISLAUS AVENUE
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0000
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Country | US
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Telephone | 209-736-0813
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Fax | 209-736-9088
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Provider Business Mailing Address
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Address Line | 768 MOUNTAIN RANCH ROAD
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City | SAN ANDREAS
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State | CA
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Zip | 95249-9707
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Country | US
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Telephone | 209-754-2520
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Fax | 209-754-2681
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CHRIS ROBERTS
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Credential |
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Telephone | 209-754-2614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 030000058
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License Number State | CA
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