Provider Demographics
NPI:1609876499
Name:MESQUITE MEDICAL ASSOCIATES,LTD
Entity Type:Organization
Organization Name:MESQUITE MEDICAL ASSOCIATES,LTD
Other - Org Name:MESQUITE MEDICAL ASSOCIATES, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-8071
Mailing Address - Street 1:1830 MESQUITE AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5885
Mailing Address - Country:US
Mailing Address - Phone:928-855-8071
Mailing Address - Fax:928-855-6869
Practice Address - Street 1:1830 MESQUITE AVE
Practice Address - Street 2:STE. A
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5885
Practice Address - Country:US
Practice Address - Phone:928-855-8071
Practice Address - Fax:928-855-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0010610OtherBCBS
AZ0010610OtherBCBS
Z0000BGFFCMedicare ID - Type Unspecified