1548404569 NPI number — WILLIAM M MESZAROS MD PC

Table of content: (NPI 1548404569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548404569 NPI number — WILLIAM M MESZAROS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM M MESZAROS MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARIZONA PERFORMANCE SPORTS MEDICINE AND ORTHOPAEDICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548404569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 N 16TH ST
Provider Second Line Business Mailing Address:
STE B232
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-553-7993
Provider Business Mailing Address Fax Number:
480-553-7995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 N GREENFIELD RD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-5044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-553-7993
Provider Business Practice Location Address Fax Number:
480-553-7995
Provider Enumeration Date:
04/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MESZAROS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
480-553-7993

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  40346 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: 40346 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 424406 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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