Medmark Treatment Services, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

28-04 Issued in CA

Legal business name

MEDMARK TREATMENT SERVICES, INC.

Practice address

1628 Broadway St
Vallejo, CA 94590-2405

Phone

(707) 649-8300

NPI assigned

Nov 30, 2012

Last updated

Jul 29, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Tax ID family

Medmark Treatment Centers - Fairfield Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Medmark Treatment Centers - Fairfield, Inc.

  • Methadone Clinic
  • Fairfield, CA
  • NPI 1669534491
  NPD tax ID

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

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1548505639",
    "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": "1628 BROADWAY ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902405",
            "telephone_number": "707-649-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-30",
        "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": "CA",
            "license": "28-04",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Office of Concepcion and Lim
• Jackqueline Medina
• Katherine Leones Medina, PHARM.D
• Ladonna Medina, BCEP
• Miriam Medina
• Medmek Medical Clinic, Inc.
• Michael C. Meehan, MD
• Ahia Meeks-Posey
• Katherine Leora Mefferd
• Desiree Loucille Mefford

• Methadone Clinic in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Methadone Clinic in California

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.