| Organization Name: | MARK TWAIN MEDICAL CENTER |
| NPI Number: | 1255730545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACOB LEWIS (CFO) |
| Mailing Address: | 768 Mountain Ranch Rd San Andreas |
| State: | CA US |
| Postal Code: | 952499707 |
| Phone Number: | 2097543521 |
| Fax Number: | 2097542652 |
| NPI Enumeration Date: | 08/22/2014 |
| NPI Last Update Date: | 08/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | LCSW61487 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |