Organization
MARK TWAIN MEDICAL CENTER
Active
Parent organization
MARK TWAIN MEDICAL CENTER
Other names
Family Medical Center - Angels Camp
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARK TWAIN MEDICAL CENTER
Authorized official
CHRIS ROBERTS (CHIEF FINANCIAL OFFICER)
(209) 754-2614
Entity
Organization
Contact information
Practice address
590 STANISLAUS AVENUE, ANGELS CAMP, CA 95222-0000
(209) 736-0813
(209) 736-9088
Mailing address
768 MOUNTAIN RANCH ROAD, SAN ANDREAS, CA 95249-9707
(209) 754-2520
(209) 754-2681
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
030000058
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
IRS - TAX ID
—
05
—
RHM18574F
—
CA
01
—
ZZZ61267Z
BLUE SHIELD OF CA
—
Enumeration date
12/14/2006
Last updated
06/09/2020
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