Healthcare Provider Details

I. General information

NPI: 1528006012
Provider Name (Legal Business Name): MESA UNITED MEDICAL INVESTORS LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S PINNULE CIR
MESA AZ
85206-1636
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-0687
  • Fax: 480-396-5011
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-372
License Number StateAZ

VII. Legacy identifiers

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

# 1
Identifier040569
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: CINDY S CROSS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 423-473-5867