PROVIDER PROVIDER PC NPI 1760969190

NPI Information

  • NPI: 1760969190
  • Provider Name: PROVIDER PROVIDER PC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 841 W 11TH ST
    MESA, AZ
    ZIP 85201
  • Phone: (480) 461-9822

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NPI Details

PROVIDER PROVIDER PC is a general practice in Mesa, AZ. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PROVIDER PROVIDER PC NPI is 1760969190. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

841 W 11TH ST
MESA, AZ
ZIP 85201-109
Phone: (480) 461-9822

The provider's authorized official is Jonathan Harris .
The authorized official title is Pa-c/member Of Corporation and has the following contact phone number (480) 461-9822.

The enumeration date for this NPI number is 7/28/2018 and was last updated on 12/20/2018.

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
1208D00000XGeneral PracticeYes

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: 11/21/2025

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