Provider Demographics
NPI:1275409112
Name:GOLDEN MESA LLC
Entity type:Organization
Organization Name:GOLDEN MESA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MGR. OF RESEARCH & INNOVATION
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-491-6066
Mailing Address - Street 1:1005 S CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4282
Mailing Address - Country:US
Mailing Address - Phone:903-491-6066
Mailing Address - Fax:
Practice Address - Street 1:1836 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5800
Practice Address - Country:US
Practice Address - Phone:469-795-4434
Practice Address - Fax:469-795-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care