Provider Demographics
NPI:1578842209
Name:MESQUITE MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MESQUITE MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSN/MBA/HCM, FNP
Authorized Official - Phone:520-234-6176
Mailing Address - Street 1:861 W YUCCA SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-8308
Mailing Address - Country:US
Mailing Address - Phone:520-234-6176
Mailing Address - Fax:
Practice Address - Street 1:77 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1813
Practice Address - Country:US
Practice Address - Phone:520-459-8915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP 4146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty