Provider Demographics
NPI:1346472982
Name:MESA WEST MEDICAL PA
Entity Type:Organization
Organization Name:MESA WEST MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-328-4793
Mailing Address - Street 1:1470 GEORGE DIETER DR
Mailing Address - Street 2:STE F
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7678
Mailing Address - Country:US
Mailing Address - Phone:915-599-9993
Mailing Address - Fax:915-599-9050
Practice Address - Street 1:1470 GEORGE DIETER DR
Practice Address - Street 2:STE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7678
Practice Address - Country:US
Practice Address - Phone:915-599-9993
Practice Address - Fax:915-599-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-16
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty