Provider Demographics
NPI:1144601634
Name:NORTH MESA STREET MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:NORTH MESA STREET MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:630-926-3408
Mailing Address - Street 1:100 TOWER DR
Mailing Address - Street 2:232
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5777
Mailing Address - Country:US
Mailing Address - Phone:630-926-3408
Mailing Address - Fax:
Practice Address - Street 1:4532 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6102
Practice Address - Country:US
Practice Address - Phone:630-926-3408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty