Provider Demographics
NPI:1093028268
Name:MESA RADIOLOGY, P.A.
Entity Type:Organization
Organization Name:MESA RADIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-236-5517
Mailing Address - Street 1:2607 WOLFLIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2607 WOLFLIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1825
Practice Address - Country:US
Practice Address - Phone:806-236-5517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty