Provider Demographics
NPI:1508179144
Name:MESA MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:MESA MEDICAL SERVICES, PC
Other - Org Name:MESA FAMILY AND URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:UZOMA
Authorized Official - Last Name:OJIAKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-887-0080
Mailing Address - Street 1:906 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5246
Mailing Address - Country:US
Mailing Address - Phone:575-887-0080
Mailing Address - Fax:575-887-0089
Practice Address - Street 1:906 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5246
Practice Address - Country:US
Practice Address - Phone:575-887-0080
Practice Address - Fax:575-887-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4313490261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care