MEDMARK TREAMENT SERVICES (NPI# 1548505639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548505639 |
| Entity Type | Organization |
| Organization Name | MEDMARK TREAMENT SERVICES |
| Practice Address |
1628 Broadway St Vallejo CA 94590-2405 |
| Mailing Address |
1720 Lakepointe Dr Ste 117 Lewisville TX 75057-6425 |
| Practice Telephone | 7076498300 |
| Mailing Telephone | 2143793300 |
| Mailing Fax Number | 2148539018 |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2020-07-15 |
| Authorized Official Name | BOND ANDREWS (VP, REVENUE CYCLE MANAGEMENT) |
| Authorized Official Telephone | 2143793398 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
28-04 | CA | Ambulatory Health Care Facilities |
| Street Address |
1628 BROADWAY ST |
| City | VALLEJO |
| State | CA |
| Zip Code | 94590-2405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730391319 | Rashid Akbar Islam | Legal Medicine | 1628 Broadway St, Vallejo, CA 94590 | 2007-05-04 |
| 1699399634 | Angelica Mendoza | Specialist/Technologist, Other | 1628 Broadway St, Vallejo, CA 94590-2405 | 2020-06-05 |
| 1467076497 | William Arthur Joyce | Licensed Vocational Nurse | 1628 Broadway St, Vallejo, CA 94590-2405 | 2020-06-05 |
| 1245853399 | Puneet Grewal | Licensed Vocational Nurse | 1628 Broadway St, Vallejo, CA 94590-2405 | 2020-05-23 |
| 1215550306 | Aminah Him | Licensed Vocational Nurse | 1628 Broadway St, Vallejo, CA 94590-2405 | 2020-05-22 |
| 1164955530 | Marquita King | Counselor | 1628 Broadway St, B, Vallejo, CA 94590-2405 | 2017-04-04 |
| 1912451410 | Stephanie Dorsey | Counselor | 1628 Broadway St, Vallejo, CA 94590-2405 | 2016-08-12 |
| 1790149672 | Sheila Kennedy | Counselor | 1628 Broadway St, Vallejo, CA 94590-2405 | 2016-04-07 |
| 1235596073 | Latisha Calhoun | Counselor | 1628 Broadway St, Vallejo, CA 94590-2405 | 2016-01-25 |
| 1932446028 | Samuel Eric Patterson | Counselor | 1628 Broadway St, B, Vallejo, CA 94590-2405 | 2013-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265051445 | Jaspreet Bains | Licensed Vocational Nurse | 508 Alabama Street, Vallejo, CA 94590 | 2020-04-08 |
| 1467097527 | Deneane Hannon | Behavioral Analyst | 238 Georgia St. Ste 102, Vallejo, CA 94590 | 2019-11-13 |
| 1780243196 | Abla Harara Almoraissi | Health Educator | John F. Kennedy Library, 505 Santa Clara St, Vallejo, CA 94590 | 2019-06-10 |
| 1891264461 | Brian Emory Kellogg | Marriage & Family Therapist | 525 Oregon St., Php/iop, Vallejo, CA 94590 | 2018-11-13 |
| 1952801862 | Carica Theresa Saraza Macariola | Specialist/Technologist | 1007 Solano Avenue, Vallejo, CA 94590 | 2018-02-16 |
| 1770007973 | Deborah A Johnson-white | Licensed Vocational Nurse | 908 Tuolumne, Vallejo, CA 94590 | 2017-07-29 |
| 1306378260 | Edgar Diaz | Counselor | 236 Georgia Street Suite 101, Vallejo, CA 94590 | 2017-03-30 |
| 1528440096 | Soren Perry | Counselor | 236 Georgia St., Vallejo, CA 94590 | 2015-06-22 |
| 1518366327 | Kimberly A Holland | Counselor | 631 Tennessee Street Suite 201, Vallejo, CA 94590 | 2014-08-18 |
| 1841605193 | Lawana Lofton | Psychologist | 88 Valle Vista Drive, Unit 6310, Vallejo, CA 94590 | 2014-06-25 |
| Find all providers in zip 94590 | ||||
| Taxonomy Code | 261QM2800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Methadone Clinic |
| An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083224141 | Aegis Treatment Centers, LLC | Clinic/Center | 1450 Bessie Ave Ste B, Tracy, CA 95376-3456 | 2020-08-04 |
| 1093323222 | City and County of San Francisco | Clinic/Center | 1001 Potrero Ave # Ward86, San Francisco, CA 94110-3518 | 2020-07-14 |
| 1548899644 | Bella Team Ltd. | Clinic/Center | 2618 San Miguel Dr Ste 1288, Newport Beach, CA 92660-5437 | 2020-04-02 |
| 1386280899 | Western Pacific Med-corp | Clinic/Center | 26921 Crown Valley Pkwy Ste 200, Mission Viejo, CA 92691-6501 | 2019-11-19 |
| 1518501527 | Harmonic Solutions LLC | Clinic/Center | 1776 Ygnacio Valley Rd Ste 206, Walnut Creek, CA 94598-3125 | 2019-11-01 |
| 1326698887 | Aegis Treatment Centers, LLC | Clinic/Center | 2107, 2109 & 2113 1st St, Eureka, CA 95501-0840 | 2019-09-17 |
| 1548819550 | Aegis Treatment Centers, LLC | Clinic/Center | 1111 W Inyokern Rd Ste B, Ridgecrest, CA 93555-2370 | 2019-09-11 |
| 1306326699 | Kristen Andree Rickard | Clinic/Center | 1153 Paradise Trail Rd, Chula Vista, CA 91915-2502 | 2018-08-16 |
| 1083141600 | Baart Behavioral Health Services, Inc. | Clinic/Center | 1145 Market St Fl 10, San Francisco, CA 94103-1566 | 2017-05-13 |
| 1013448547 | Coachella Valley Treatment Center | Clinic/Center | 81709 Dr Carreon Blvd Ste B1, Indio, CA 92201-5510 | 2017-03-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.