Provider Demographics
NPI:1497447916
Name:M A C T HEALTH BOARD, INCORPORATED
Entity Type:Organization
Organization Name:M A C T HEALTH BOARD, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SHAWVER
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:209-754-6275
Practice Address - Street 1:5204 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9524
Practice Address - Country:US
Practice Address - Phone:209-966-0573
Practice Address - Fax:209-742-6321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M A C T HEALTH BOARD, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-23
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366519431OtherGROUP NPI