Provider Demographics
NPI:1265640478
Name:MESA ORTHOPEDIC INC
Entity Type:Organization
Organization Name:MESA ORTHOPEDIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER-CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:970-242-3210
Mailing Address - Street 1:2305 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8117
Mailing Address - Country:US
Mailing Address - Phone:970-242-3210
Mailing Address - Fax:970-242-3219
Practice Address - Street 1:2305 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8117
Practice Address - Country:US
Practice Address - Phone:970-242-3210
Practice Address - Fax:970-242-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08712036Medicaid
CO08712036Medicaid
CO=========001OtherRMHP