NPIMap

Organization Active NPI

Medmark Treatment Centers of Alabama, Inc.

  • Methadone Clinic
  • Newton, AL
National Provider Identifier
1114398799
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
MEDMARK TREATMENT CENTERS OF ALABAMA, INC.
Practice address
9283 W US 84
Newton, AL 36352-8207
Phone
(214) 379-3300
Fax
(214) 379-3324
NPI assigned
Oct 8, 2015
Organization subpart
Yes
Parent organization
MEDMARK SERVICES, INCAs reported in NPPES

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

9283 W US 84
Newton, AL 36352-8207

Mailing address

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

Other names 1

  • Medmark Treatment Centers- Dothan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200107003155 AL Part B Supplier - Opioid Treatment Program (Otp) 8820422496 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newton, AL; Oxford, AL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
01D2104548Medmark Treatment Centers of Alabama, Inc9283 US 84 West, Newton, AL 36352Certificate of waiverNov 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medmark Treatment Centers of Alabama Inc2 organizations share this tax ID, including this one
Part of
Medmark Services Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1114398799",
    "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": "9283 W US 84",
            "city": "NEWTON",
            "state": "AL",
            "postal_code": "363528207",
            "telephone_number": "214-379-3300",
            "fax_number": "214-379-3324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS OF ALABAMA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDMARK SERVICES, INC",
        "enumeration_date": "2015-10-08",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medmark Treatment Centers- Dothan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medmark Treatment Centers- Dothan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newton, AL

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.