Provider Demographics
NPI:1740790195
Name:MESA PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MESA PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-245-0990
Mailing Address - Street 1:2460 PATTERSON RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1027
Mailing Address - Country:US
Mailing Address - Phone:970-245-0990
Mailing Address - Fax:970-644-6446
Practice Address - Street 1:2460 PATTERSON RD UNIT 4
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1027
Practice Address - Country:US
Practice Address - Phone:970-245-0990
Practice Address - Fax:970-644-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain