MESA PHYSICAL MEDICINE PLLC (NPI# 1154774305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154774305 |
| Entity Type | Organization |
| Organization Name | MESA PHYSICAL MEDICINE PLLC |
| Practice Address |
2919 S Ellsworth Rd Suite 102 Mesa AZ 85212-2164 |
| Practice Telephone | 4803542008 |
| Mailing Telephone | 4803542008 |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2016-09-30 |
| Authorized Official Name | DR. SCOTT TAYLOR (CEO) |
| Authorized Official Telephone | 4809071322 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
AP4338 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2919 S ELLSWORTH RD SUITE 102 |
| City | MESA |
| State | AZ |
| Zip Code | 85212-2164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972502862 | Gabriel U. Ogbonnaya | Internal Medicine | 2919 S Ellsworth Rd, Suite # 124, Mesa, AZ 85212-2164 | 2005-07-21 |
| 1912331158 | Southwest Spine & Rehab Pllc | Chiropractor | 2919 S Ellsworth Rd, Suite 102, Mesa, AZ 85212-2164 | 2013-08-23 |
| 1225381999 | Amy Lynn Wagner | Naturopath | 2919 S Ellsworth Rd, Suite 109, Mesa, AZ 85212-2164 | 2012-10-18 |
| 1023381340 | Scott Alexander Taylor | Chiropractor | 2919 S Ellsworth Rd, 102, Mesa, AZ 85212-2164 | 2012-02-16 |
| 1326344375 | Choice Medical Imaging of Arizona, LLC | Clinic/Center | 2919 S Ellsworth Rd, Suite 101, Mesa, AZ 85212-2164 | 2011-02-08 |
| 1881928273 | Kate Ashley Maine | Physician Assistant | 2919 S Ellsworth Rd, Mesa, AZ 85212-2164 | 2009-10-01 |
| 1710148663 | Custom Smile LLC | Dentist | 2919 S Ellsworth Rd, Suite 141, Mesa, AZ 85212-2164 | 2008-06-23 |
| 1508024175 | Aimee Lynn Hada | Physician Assistant | 2919 S Ellsworth Rd, Ste. 124, Mesa, AZ 85212-2164 | 2008-05-29 |
| 1003089301 | Kristy K Brown | Speech-Language Pathologist | 2919 S Ellsworth Rd, Suite 111, Mesa, AZ 85212-2164 | 2008-04-08 |
| 1003089384 | Deborah A Mordhorst | Physical Therapist | 2919 S Ellsworth Rd, Suite 111, Mesa, AZ 85212-2164 | 2008-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922610302 | West Point Optical Group | Optometrist | 10706 E Point Twenty-two Blvd, #107, Mesa, AZ 85212 | 2020-08-18 |
| 1215553565 | Andrew Eugene Pak | Dentist | 10664 East Point Twenty-two Blvd, Mesa, AZ 85212 | 2020-06-23 |
| 1588200265 | Signal Butte Kids Dentistry and Orthodontics, LLP | Dentist | 10664 E. Point Twenty Two Blvd, Mesa, AZ 85212 | 2019-11-18 |
| 1194371526 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 4316 S Signal Butte Rd, Mesa, AZ 85212 | 2019-08-12 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1033623541 | Latanya Olivia Edenburgs | Case Manager/Care Coordinator | 10436 E Radiant Ave., Mesa, AZ 85212 | 2017-11-20 |
| 1205355880 | Linda Okafor | Nurse Practitioner | 4719 S Calderon Circle, Mesa, AZ 85212 | 2017-09-14 |
| 1689121188 | Agh Mesa LLC | General Acute Care Hospital | 9130 East Elliot Road, Mesa, AZ 85212 | 2016-09-01 |
| 1861841918 | Ryan Blake | Dentist | 4425 S. Mountain Road, Ste 109, Mesa, AZ 85212 | 2016-06-09 |
| 1083089460 | White Glove Health | Nurse Practitioner | 2906 S Lynch Cr, Mesa, AZ 85212 | 2015-12-10 |
| Find all providers in zip 85212 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447864202 | Soma Care, LLC | Nurse Practitioner | 6944 E Broadway Rd Ste A, Mesa, AZ 85208-1916 | 2020-08-31 |
| 1245851955 | Amy Rachelle Dunn | Nurse Practitioner | 7563 E Plata Ave, Mesa, AZ 85212-9729 | 2020-05-04 |
| 1326683376 | Little Sanctuary Health Center | Nurse Practitioner | 840 W Southern Ave, Mesa, AZ 85210-4901 | 2019-11-14 |
| 1306356746 | Christine Elizabeth Claybrook | Nurse Practitioner | 6859 E Rembrandt Ave Ste 117, Mesa, AZ 85212-3630 | 2017-10-11 |
| 1073041331 | Michelle Resendez | Nurse Practitioner | 2500 S Power Rd, Bldg 7, Ste 218, Mesa, AZ 85209 | 2017-05-31 |
| 1730320623 | Kay Lynn Southwell | Nurse Practitioner | 6242 E Arbor Ave Suite 111, Mesa, AZ 85206-2809 | 2009-03-23 |
| 1306491113 | Abigail Lee Moreno | Nurse Practitioner | 7525 E Broadway Rd Ste 11, Mesa, AZ 85208-1156 | 2019-08-08 |
| 1932623469 | John Risi | Nurse Practitioner | 2266 S Dobson Rd Ste 200, Mesa, AZ 85202 | 2017-07-26 |
| 1720467418 | Sung E Cho | Nurse Practitioner | 1705 W Main St, Mesa, AZ 85201-6920 | 2015-05-27 |
| 1770810715 | Priscilla Marie Luong | Nurse Practitioner | 5602 E Main St, Mesa, AZ 85205-8813 | 2009-11-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.