Healthcare Provider Details

I. General information

NPI: 1477979276
Provider Name (Legal Business Name): CITY OF MESA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W 1ST ST
MESA AZ
85201-6613
US

IV. Provider business mailing address

13 W 1ST ST
MESA AZ
85201-6613
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-2101
  • Fax:
Mailing address:
  • Phone: 480-644-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JASON TAYLOR
Title or Position: SR. AUDITOR
Credential:
Phone: 480-644-2101