M A C T Health Board Incorporated | |
1113 Highway 49 San Andreas CA 95249 | |
(209) 754-6262 | |
(209) 674-6211 |
Full Name | M A C T Health Board Incorporated |
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Speciality | Clinic/Center |
Location | 1113 Highway 49, San Andreas, California |
Authorized Official Name and Position | John Alexander (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2097546262 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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M A C T Health Board Incorporated Po Box 939 Angels Camp CA 95222-0939 Ph: (209) 754-6262 | M A C T Health Board Incorporated 1113 Highway 49 San Andreas CA 95249 Ph: (209) 754-6262 |
NPI Number | 1366519431 |
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Provider Enumeration Date | 11/30/2006 |
Last Update Date | 07/26/2022 |
Medicare PECOS PAC ID | 8325936974 |
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Medicare Enrollment ID | O20040305001143 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366519431 | NPI | - | NPPES |
THP70732F | Medicaid | CA | |
THP70871F | Medicaid | CA | |
THP70018F | Medicaid | CA | |
THP70875F | Medicaid | CA | |
THP70776F | Medicaid | CA | |
GR0090620 | Medicaid | CA |
Provider Name | Deborah F Wong |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1952363178 PECOS PAC ID: 6002879624 Enrollment ID: I20041104001105 |
Provider Name | Ravinder Kadevari |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306873922 PECOS PAC ID: 0143271056 Enrollment ID: I20050208001057 |
Provider Name | Gabriel Rau Pettersen |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1740251727 PECOS PAC ID: 3274559406 Enrollment ID: I20051018000344 |
Provider Name | Janet Louise Black |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1861472060 PECOS PAC ID: 1850305764 Enrollment ID: I20060131000266 |
Provider Name | Charles L Edwards |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1063505972 PECOS PAC ID: 1456369974 Enrollment ID: I20060324000538 |
Provider Name | Elisabeth Siegler |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1326038787 PECOS PAC ID: 3072619485 Enrollment ID: I20070501000654 |
Provider Name | Russell N Cotteral |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1619911047 PECOS PAC ID: 5092811059 Enrollment ID: I20070508000358 |
Provider Name | Alton J Smalley |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1316946551 PECOS PAC ID: 4385735083 Enrollment ID: I20070809000728 |
Provider Name | Robert Reina |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1295739845 PECOS PAC ID: 6406917475 Enrollment ID: I20081209000545 |
Provider Name | Estevan Acuna |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104821032 PECOS PAC ID: 8729133061 Enrollment ID: I20090909000778 |
Provider Name | Douglas Fleming |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1871524611 PECOS PAC ID: 9335289966 Enrollment ID: I20091212000009 |
Provider Name | Walter Kip Johnson |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1780919282 PECOS PAC ID: 1557401593 Enrollment ID: I20091222000598 |
Provider Name | Julianah Adenike Olabode |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699929042 PECOS PAC ID: 0648451476 Enrollment ID: I20110225000743 |
Provider Name | Donald K Bojnowski |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1922385061 PECOS PAC ID: 4385810449 Enrollment ID: I20111220000894 |
Provider Name | Sikhnandan S Sidhu |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1306931522 PECOS PAC ID: 8022272079 Enrollment ID: I20120604000367 |
Provider Name | Christopher L Jones |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1649594417 PECOS PAC ID: 8123249703 Enrollment ID: I20141023001998 |
Provider Name | Chrystal A L Bradley |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1366886392 PECOS PAC ID: 2961718176 Enrollment ID: I20150902003131 |
Provider Name | Cecilia Inez Mcpherson |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1558733972 PECOS PAC ID: 3870893050 Enrollment ID: I20151216001427 |
Provider Name | Angelo J Chavez Guerrero |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1235465774 PECOS PAC ID: 9537296132 Enrollment ID: I20160225001197 |
Provider Name | Sara M Ray |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1902248214 PECOS PAC ID: 0840559191 Enrollment ID: I20180115000185 |
Provider Name | Matthew G Richardson |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1912028812 PECOS PAC ID: 6608113428 Enrollment ID: I20190131001834 |
Provider Name | Andrew James Skokan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245800416 PECOS PAC ID: 7719389113 Enrollment ID: I20210707003573 |
Provider Name | Christy Hobgood |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1316482136 PECOS PAC ID: 6103228242 Enrollment ID: I20210712002196 |
Provider Name | Wendy J Carvajal |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1740587229 PECOS PAC ID: 6800287475 Enrollment ID: I20211216000432 |
Provider Name | Cherie Lynn Lafleur |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750955167 PECOS PAC ID: 0840671939 Enrollment ID: I20220720003482 |
Provider Name | Fawad Zadran |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1891360111 PECOS PAC ID: 3678979622 Enrollment ID: I20220907000416 |
Provider Name | Benjamin Robert Mcpherson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912639758 PECOS PAC ID: 3577934397 Enrollment ID: I20230113001398 |
Provider Name | Gwendelyn De Guzman Enriquez |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1588709547 PECOS PAC ID: 7113399528 Enrollment ID: I20230213001812 |
Provider Name | Livia Speare Galli Rasmussen |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1417618117 PECOS PAC ID: 9931563061 Enrollment ID: I20230907004022 |
Provider Name | Catherine Ann Sullivan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821335688 PECOS PAC ID: 1052765302 Enrollment ID: I20230920004320 |
Provider Name | Susan Margaret Abeldt |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1174816425 PECOS PAC ID: 7618323635 Enrollment ID: I20231027001475 |
Provider Name | Gary M Krupa |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1720164627 PECOS PAC ID: 3870644297 Enrollment ID: I20231228003126 |
Provider Name | Daniel Joseph Duron |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164299921 PECOS PAC ID: 6507219672 Enrollment ID: I20240125002177 |
Provider Name | Emma Rae Roots |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841054400 PECOS PAC ID: 4385080944 Enrollment ID: I20240308002256 |
Provider Name | Patricia Rivas |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1104864818 PECOS PAC ID: 4183060312 Enrollment ID: I20240311002777 |
Provider Name | Nina M Tecson |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1477840700 PECOS PAC ID: 4880970565 Enrollment ID: I20240311003464 |
Provider Name | Kirmanj Atrushi |
---|---|
Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1871026179 PECOS PAC ID: 7911329354 Enrollment ID: I20240321002694 |
Mountain Oak Health Centers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 556 Mountain Ranch Road, San Andreas, CA 95249 Phone: 209-498-2014 Fax: 209-498-2143 | |
Galen Inpatient Physicians, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 768 Mountain Ranch Rd, San Andreas, CA 95249 Phone: 209-754-3521 | |
Family Medical Center - San Andreas Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 704 Mountain Ranch Rd, San Andreas, CA 95249 Phone: 209-754-3521 | |
Mark Twain Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 768 Mountain Ranch Rd, San Andreas, CA 95249 Phone: 209-754-3521 Fax: 209-754-2652 | |
Gold Rush Inpatient Services, A Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 768 Mountain Ranch Rd, San Andreas, CA 95249 Phone: 209-754-3521 | |
Mact Medical San Andreas Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1113 Hwy 49, San Andreas, CA 95249 Phone: 209-755-1400 Fax: 209-755-1430 |