Provider Demographics
NPI:1821295502
Name:MESA GASTROINTESTINAL ASSOC PC
Entity Type:Organization
Organization Name:MESA GASTROINTESTINAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-461-1088
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:STE 302
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-461-1088
Mailing Address - Fax:480-461-1657
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:STE 302
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-461-1088
Practice Address - Fax:480-461-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZWCHSKMedicare UPIN