Provider Demographics
NPI:1124389770
Name:MESA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:MESA MEDICAL GROUP LLC
Other - Org Name:BACKFIT HEALTH & SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZITNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-830-2882
Mailing Address - Street 1:1450 W GUADALUPE RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3042
Mailing Address - Country:US
Mailing Address - Phone:480-926-7800
Mailing Address - Fax:480-926-2260
Practice Address - Street 1:5233 E SOUTHERN AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3625
Practice Address - Country:US
Practice Address - Phone:480-820-2882
Practice Address - Fax:480-830-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7150111N00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicare UPIN