Medmark Treatment Center Fresno

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

VN258988 Issued in CA

Legal business name

MEDMARK TREATMENT CENTER FRESNO

Practice address

1310 M St
Fresno, CA 93721-1808

Phone

(559) 264-2700

NPI assigned

Feb 15, 2012

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 Center Fresno3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Medmark Treatment Centers - Fresno West, Inc.

  • Methadone Clinic
  • Fresno, CA
  • NPI 1568676575
  NPD tax ID
• Medmark Treatment Centers, Inc.

  • Health Maintenance Organization
  • Fresno, CA
  • NPI 1649676412
  NPD tax ID

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1851664262",
    "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": "1310 M ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211808",
            "telephone_number": "559-264-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTER FRESNO",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "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": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": "VN258988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Elaine Medina, MS
• Mediva LLC
• Medline Medical Center
• Aubree Medlock
• Laurel J Medlock
• Medmark Treatment Centers - Fresno West, Inc.
• Medmark Treatment Centers-Fresno East, Inc.
• Medmark Treatment Centers, Inc.
• Medmark1
• Elida Medrano-Camarillo

• Case Manager/Care Coordinator in Fresno, CA
• Providers in Fresno, CA by specialty
• Case Manager/Care Coordinator 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.