MESA PHYSICAL MEDICINE PLLC NPI 1154774305

NPI Information

NPI: 1154774305
Provider Name: MESA PHYSICAL MEDICINE PLLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 03D2260313

Address:
2919 S ELLSWORTH RD
SUITE 102
MESA, AZ
ZIP 85212
Phone: (480) 354-2008
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MESA PHYSICAL MEDICINE PLLC is a primary care nurse practitioner in Mesa, AZ. MESA PHYSICAL MEDICINE PLLC NPI is 1154774305. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2919 S ELLSWORTH RD
SUITE 102
MESA, AZ
ZIP 85212-164
Phone: (480) 354-2008

The provider's authorized official is Scott Taylor .
The authorized official title is Ceo and has the following contact phone number (480) 907-1322.

The CLIA number assigned to this NPI record is 03D2260313 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/22/2016 and was last updated on 9/30/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care	AP4338	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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