Provider Demographics
NPI:1467444364
Name:M A C T HEALTH BOARD, INCORPORATED
Entity Type:Organization
Organization Name:M A C T HEALTH BOARD, INCORPORATED
Other - Org Name:MACT MEDICAL SONORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-754-6258
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6262
Mailing Address - Fax:209-754-6274
Practice Address - Street 1:13975 MONO WAY
Practice Address - Street 2:SUITE G, H & I
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2824
Practice Address - Country:US
Practice Address - Phone:209-533-9600
Practice Address - Fax:209-533-9608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACT HEALTH BOARD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000704261Q00000X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP70875FMedicaid
CAZZZ18354ZMedicare PIN