Medmark Treatment Centers - Fairfield, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

48-03 Issued in CA

Legal business name

MEDMARK TREATMENT CENTERS - FAIRFIELD, INC.

Doing business as

MedMark Treatment Centers - Fairfield, Inc.
MedMark Treatment Centers- Fairfield, Inc

Practice address

1143 Missouri Street
Fairfield, CA 94533-6007

Phone

(707) 435-9911

Fax

(707) 435-0704

NPI assigned

Dec 15, 2006

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

Other identifiers 2

Other names 2

• MedMark Treatment Centers - Fairfield, Inc. Doing business as
• MedMark Treatment Centers- Fairfield, Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

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

CLIA laboratory certificates

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 Services, Inc.

  • Methadone Clinic
  • Vallejo, CA
  • NPI 1548505639
  NPD tax ID

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1669534491",
    "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": "1143 MISSOURI STREET",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336007",
            "telephone_number": "707-435-9911",
            "fax_number": "707-435-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS - FAIRFIELD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "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": "48-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48AA",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "48AA",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers - Fairfield, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedMark Treatment Centers- Fairfield, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Josie Medina
• Manuel Amado Medina
• Maryfatima Medina
• Pablo Oscar Medina Jr., M.D.
• Rocio Medina
• Jocelyn M Medrano, AMFT
• Medxpress
• Megha Jadhav DMD, Inc
• Navid Mehranpour, D.D.S.
• Dolly Gagan Mehta

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; 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.