Healthcare Provider Details

I. General information

NPI: 1508179144
Provider Name (Legal Business Name): MESA MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2010
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W PIERCE ST
CARLSBAD NM
88220-5246
US

IV. Provider business mailing address

906 W PIERCE ST
CARLSBAD NM
88220-5246
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-0080
  • Fax: 575-887-0089
Mailing address:
  • Phone: 575-887-0080
  • Fax: 575-887-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4313490
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4313490
License Number StateNM

VIII. Authorized Official

Name: DR. HERBERT UZOMA OJIAKU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 575-887-0080