NPIMap

Organization Active NPI

Medmark Treatment Centers of Texas, Inc.

Doing business as MedMark Treatment Centers Waco

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waco, TX
National Provider Identifier
1083931562
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1000028 Issued in TX
Legal business name
MEDMARK TREATMENT CENTERS OF TEXAS, INC.
Doing business as
MedMark Treatment Centers Waco
Practice address
2210 Washington Ave
Waco, TX 76701-1019
Phone
(254) 755-6411
Fax
(254) 755-6422
NPI assigned
Apr 23, 2010
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 0000058 TX
Methadone Clinic 261QM2800X 1000028 TX
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1000028 TX Primary

Addresses

Primary practice location

2210 Washington Ave
Waco, TX 76701-1019

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (214) 379-3300

Other identifiers 2

IdentifierTypeStateIssuer
285947201MedicaidTX
1000028OtherTXST LICENSE

Other names 1

  • MedMark Treatment Centers Waco Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opioid treatment program
Medicare-enrolled since May 20, 2026

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2026181Medmark Treatment Centers of Texas, Inc2210 Washington Ave, Waco, TX 76701Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory

Locations

2210 Washington Ave
Waco, TX 76701
Phone (254) 274-3554

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1083931562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300",
            "fax_number": "214-853-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 WASHINGTON AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767011019",
            "telephone_number": "254-755-6411",
            "fax_number": "254-755-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS OF TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "TX",
            "license": "0000058",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "TX",
            "license": "1000028",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TX",
            "license": "1000028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285947201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LICENSE",
            "identifier": "1000028",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Waco",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.