Provider Demographics
NPI:1407016793
Name:DOCTORS MEDICAL CENTER
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER
Other - Org Name:DOCTORS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARTAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-557-6309
Mailing Address - Street 1:1501 CLAUS RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9711
Mailing Address - Country:US
Mailing Address - Phone:209-557-6300
Mailing Address - Fax:209-557-6386
Practice Address - Street 1:1441 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4405
Practice Address - Country:US
Practice Address - Phone:209-576-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital