Provider Demographics
NPI:1912140005
Name:MESA URGENT CARE, LLC
Entity Type:Organization
Organization Name:MESA URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LEVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-844-9188
Mailing Address - Street 1:963 E KRAMER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-1935
Mailing Address - Country:US
Mailing Address - Phone:480-844-9188
Mailing Address - Fax:
Practice Address - Street 1:1242 E. MCKELLIPS RD. #103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:480-844-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTBD261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1467405894OtherNPI
AZ128688Medicaid
AZ108194Medicare PIN
AZ1467405894OtherNPI