Organization
MSK CENTER OF MESA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BLOOM (OWNER)
(480) 357-6500
Entity
Organization
Contact information
Practice address
8427 E BASELINE RD STE 101, MESA, AZ 85209-4381
(480) 357-6500
Mailing address
8427 E BASELINE RD STE 101, MESA, AZ 85209-4381
(480) 357-6500
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083025423
NPI
AZ
01
—
1710185384
NPI
TN
01
—
1730480666
NPI
AZ
01
—
1962819235
NPI
NY
Enumeration date
09/21/2021
Last updated
09/21/2021
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