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NPI Code Detail

MEDICARE: MEDMARK TREATMENT CENTERS - STOCKTON, INC.

MEDICARE: MEDMARK TREATMENT CENTERS - STOCKTON, 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 Clinic39-07CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
248ACOTHERCAMEDI-CAL

General Provider Information

NPI Number : 1851453500
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDMARK TREATMENT CENTERS - STOCKTON, 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 : 1111 N EL DORADO STREET
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number : 209-938-0281
Authorized Official
Title or Position : VP, TREASURER
Name : BRUCE JARVIE
Credential :
Telephone Number : 214-379-3300
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/29/2024

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1831252832 — MR. PHILLIP YASUO YOSHIMURA I PA-C
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95202-1305
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1972667236 — ANNA MARIE PENA
Practice Location Address:
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95202-1305
Practice Phone: 209-938-0228
Practice Fax: 209-938-0281

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