| Mact Medical Jackson | |
|
12140/12150 New York Ranch Rd Jackson CA 95642-9407 | |
| (209) 257-2400 | |
| (209) 257-2403 |
| Full Name | Mact Medical Jackson |
|---|---|
| Speciality | Clinic/Center |
| Location | 12140/12150 New York Ranch Rd, Jackson, 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 |
|---|---|
| Mact Medical Jackson Po Box 939 Angels Camp CA 95222-0939 Ph: (209) 754-6262 | Mact Medical Jackson 12140/12150 New York Ranch Rd Jackson CA 95642-9407 Ph: (209) 257-2400 |
| NPI Number | 1295727287 |
|---|---|
| Provider Enumeration Date | 08/17/2005 |
| Last Update Date | 11/17/2022 |
| Medicare PECOS PAC ID | 8325936974 |
|---|---|
| Medicare Enrollment ID | O20170324000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295727287 | NPI | - | NPPES |
| THP70776F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
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