Provider Demographics
NPI:1306311329
Name:MARK TWAIN HEALTH CARE DISTRICT
Entity type:Organization
Organization Name:MARK TWAIN HEALTH CARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-728-7711
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-0095
Mailing Address - Country:US
Mailing Address - Phone:209-754-4468
Mailing Address - Fax:209-754-2537
Practice Address - Street 1:51 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-0051
Practice Address - Country:US
Practice Address - Phone:209-772-7070
Practice Address - Fax:209-772-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health