Basic Information
| Provider Information | |||||||||
| NPI: | 1528639879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MESQUITE CLINIC MANAGEMENT COMPANY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26526 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049152016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 BERTHA HOWE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890277503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
| FaxNumber: | 7023460801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | FEY | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6152213641 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.