NPIMap

Organization Active NPI

Medmark Treatment Centers of Pennsylvania, Inc.

Doing business as Medmark Treatment Centers Blairsville PA

  • Methadone Clinic
  • Blairsville, PA
National Provider Identifier
1952854408
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 PENNSYLVANIA, INC.
Doing business as
Medmark Treatment Centers Blairsville PA
Practice address
1984 Route 22
Blairsville, PA 15717-1264
Phone
(724) 459-4884
Fax
(724) 459-4886
NPI assigned
Aug 2, 2016
Last updated
Jul 29, 2024By the provider in NPPES
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 PA Primary

Addresses

Primary practice location

1984 Route 22
Blairsville, PA 15717-1264

Mailing address

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

Other names 1

  • Medmark Treatment Centers Blairsville PA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Opioid treatment program
Medicare-enrolled since Jun 16, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201023001179 PA Part B Supplier - Opioid Treatment Program (Otp) 0042630493 1 other NPI on this enrollment
Practice locations: Blairsville, PA; Greensburg, PA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Medmark TRMT CTRS of PA 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.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1952854408",
    "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": "1984 ROUTE 22",
            "city": "BLAIRSVILLE",
            "state": "PA",
            "postal_code": "157171264",
            "telephone_number": "724-459-4884",
            "fax_number": "724-459-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS OF PENNSYLVANIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDMARK SERVICES, INC",
        "enumeration_date": "2016-08-02",
        "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": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medmark Treatment Centers Blairsville PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medmark Treatment Centers Blairsville PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blairsville, PA

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.