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General NPI Number Information
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NPI Number | 1083593073
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Entity Type | Organization
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Legal Business Name | 1977 MESK
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2900 OAKLAND DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-5278
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Country | US
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Telephone | 315-569-5318
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 OAKLAND DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-5278
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERICA VALLEE
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Credential |
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Telephone | 407-305-3791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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