Provider Demographics
NPI:1043910631
Name:MESA SPRINGS PHYSICIAN GROUP LLC
Entity type:Organization
Organization Name:MESA SPRINGS PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-588-3546
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:412-588-3546
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:4935 S COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1191
Practice Address - Country:US
Practice Address - Phone:682-273-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MESA SPRINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-03
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty