Organization
MARK TWAIN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CHIVERS (CHIEF FINANCIAL OFFICER)
(209) 754-2614
Entity
Organization
Contact information
Practice address
768 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9707
(209) 754-3521
(209) 754-2675
Mailing address
768 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9707
(209) 754-3521
(209) 754-2675
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
030000058
CA
282NC0060X
Critical Access Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233520100
DEPT. OF LABOR - WC
—
05
—
HSP40366G
—
CA
05
—
LTC30366G
—
CA
05
—
ZZR00366G
—
CA
01
—
ZZZC0502Z
BLUE SHIELD OF CA
—
Enumeration date
09/05/2006
Last updated
04/15/2021
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