Provider Demographics
NPI:1497382501
Name:MESA CENTER FOR FAMILY MEDICINE
Entity Type:Organization
Organization Name:MESA CENTER FOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOTTERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-525-8663
Mailing Address - Street 1:2034 S ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2034 S ALMA SCHOOL ROAD
Practice Address - Street 2:SUITE #101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:602-525-8663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty