MEDICARE: MESQUITE MEDICAL & SURGICAL CLINIC P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	F9379	TX

General Provider Information

NPI Number	:	1629128731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESQUITE MEDICAL & SURGICAL CLINIC P.A.

Provider Business Mailing Address
First Line	:	1102 N GALLOWAY AVE
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2436
Country	:	US
Telephone Number	:	972-285-5426
Fax Number	:	972-329-1433

Provider Business Practice Location Address
First Line	:	1102 N GALLOWAY AVE
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2436
Country	:	US
Telephone Number	:	972-285-5426
Fax Number	:	972-329-1433

Authorized Official
Title or Position	:	NPI COORDINATOR
Name	:	MS. LORI LEA SCOTT
Credential	:
Telephone Number	:	972-285-5426

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	11/18/2010

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