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General NPI Number Information
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NPI Number | 1578842209
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Entity Type | Organization
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Legal Business Name | MESQUITE MEDICAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 77 E FRY BLVD
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1813
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Country | US
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Telephone | 520-459-8915
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Fax |
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Provider Business Mailing Address
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Address Line | 861 W YUCCA SPRINGS TRL
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City | HUACHUCA CITY
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State | AZ
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Zip | 85616-8308
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Country | US
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Telephone | 520-234-6176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FREDERICK EUGENE POWERS JR.
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Credential | MSN/MBA/HCM, FNP
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Telephone | 520-234-6176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TAP 4146
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License Number State | AZ
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