NPIMap

Organization Active NPI

Medmark Treatment Centers - Stockton, Inc.

  • Methadone Clinic
  • Stockton, CA
National Provider Identifier
1851453500
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
39-07 Issued in CA
Legal business name
MEDMARK TREATMENT CENTERS - STOCKTON, INC.
Practice address
1111 N El Dorado Street
Stockton, CA 95202-1305
Phone
(209) 938-0228
Fax
(209) 938-0281
NPI assigned
Dec 15, 2006
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 39-07 CA Primary

Addresses

Primary practice location

1111 N El Dorado Street
Stockton, CA 95202-1305

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
48-ACMedicaidCA
48ACOtherCAMEDI-CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200204003011 CA Part B Supplier - Opioid Treatment Program (Otp) 0547696825 Practice locations: Stockton, CA

National Provider Directory

National Provider Directory
Part of
Medmark Services Inc

Locations

1111 N El Dorado St
Stockton, CA 95202
Phone (209) 451-5272

Practitioners & affiliated clinicians

Practitioners 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1851453500",
    "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": "1111 N EL DORADO STREET",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021305",
            "telephone_number": "209-938-0228",
            "fax_number": "209-938-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS - STOCKTON, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDMARK SERVICES, INC",
        "enumeration_date": "2006-12-15",
        "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": "39-07",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48-AC",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "48AC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

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

Verify at the official NPI Registry.