| Central Mesa Medical Pc | |
|
204 N Center St Mesa AZ 85201-6629 | |
| (480) 962-0868 | |
| (480) 962-7010 |
| Full Name | Central Mesa Medical Pc |
|---|---|
| Speciality | Chiropractor |
| Location | 204 N Center St, Mesa, Arizona |
| Authorized Official Name and Position | Scott L Miritello (PRESIDENT) |
| Authorized Official Contact | 4809620868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Mesa Medical Pc 204 N Center St Mesa AZ 85201-6629 Ph: (480) 962-0868 | Central Mesa Medical Pc 204 N Center St Mesa AZ 85201-6629 Ph: (480) 962-0868 |
| NPI Number | 1669509568 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 11/11/2014 |
| Medicare PECOS PAC ID | 1355320318 |
|---|---|
| Medicare Enrollment ID | O20040714001417 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669509568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 21507 (Arizona) | Secondary |
| 111N00000X | Chiropractor | 03289 (Arizona) | Primary |
| Provider Name | Leanne J Koleski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619209392 PECOS PAC ID: 0840328852 Enrollment ID: I20100512000978 |
| Provider Name | Scott L Miritello |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1912092289 PECOS PAC ID: 9638366818 Enrollment ID: I20110503000730 |
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