MEDMARK TREATMENT CENTERS OF TEXAS INC (NPI# 1770781106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770781106 |
| Entity Type | Organization |
| Organization Name | MEDMARK TREATMENT CENTERS OF TEXAS INC |
| Practice Address |
5201 Mccart Ave Suite H Fort Worth TX 76115-3711 |
| Mailing Address |
1720 Lakepointe Dr Ste 117 Lewisville TX 75057-6425 |
| Practice Telephone | 8172078700 |
| Practice Fax Number | 8172078778 |
| Mailing Telephone | 2143793300 |
| Mailing Fax Number | 2148539018 |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2020-07-15 |
| Authorized Official Name | BOND ANDREWS (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Telephone | 2143793398 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
1000027 | TX | Ambulatory Health Care Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
1000027 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 285947202 | 05 | |
| TX | LICENSE | 1000027 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083931562 | Medmark Treatment Centers of Texas Inc | Clinic/Center | 2210 Washington Ave, Waco, TX 76701-1019 | 2010-04-23 |
| Street Address |
5201 MCCART AVE SUITE H |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76115-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811400047 | Christine Vera Varela | Nurse Practitioner | Clinicas Mi Doctor, 4200 S Freeway Ste 106, Fort Worth, TX 76115 | 2017-11-09 |
| 1376081752 | Cheryl D. Mitchell | Nurse Practitioner | 11803 S. Freeway, Ste. 311, Fort Worth, TX 76115 | 2017-02-06 |
| 1508097858 | Misti Lynne Poulos | Massage Therapist | 4534 Stanley Ave, #361, Fort Worth, TX 76115 | 2009-08-04 |
| 1609015312 | Sirisha Bheemaneni | Internal Medicine | 11801 S Frwy, Fort Worth, TX 76115 | 2009-02-19 |
| 1639378292 | Jeffrey J. Raymond | Physician Assistant | 544 West Seminary Dr, Fort Worth, TX 76115 | 2007-07-13 |
| 1336367952 | Luis Sierra-nieves | Physician Assistant | 544 West Seminary Drive, Fort Worth, TX 76115 | 2007-04-20 |
| 1396861209 | Remedios R Cabansag | Obstetrics & Gynecology | 11803 So Freewax, Suite 254, Fort Worth, TX 76115 | 2007-03-22 |
| 1073602611 | Courage Rehab Clinic | Clinic/Center | 1670 North Hampton Road, Suite 110, Desoto, TX 76115 | 2006-10-12 |
| 1548369200 | Vijay Khanna | Podiatrist | 4759 B South Freeway, Ft Worth, TX 76115 | 2006-09-21 |
| 1225045164 | Allan M Wallace | Optometrist | 11803 South Frwy, Suite 114, Fort Worth, TX 76115 | 2006-08-02 |
| Find all providers in zip 76115 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1356371256 | Valley Hope Association | Clinic/Center | 3521 Nw Loop 820, Fort Worth, TX 76106-3201 | 2006-07-04 |
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| 1619539509 | Arc Counseling LLC | Clinic/Center | 5700 Nw Central Dr Ste 130, Houston, TX 77092-2000 | 2019-07-01 |
| 1982261988 | Davecolephd and Associates | Clinic/Center | 4702 Old Spanish Trl Ste 106, Houston, TX 77021-1718 | 2019-05-24 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76115 |
Please comment or provide details below to improve the information on MEDMARK TREATMENT CENTERS OF TEXAS INC.
| 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.