Provider Demographics
NPI:1487750105
Name:MESA, JOSEPH E (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-825-7200
Mailing Address - Fax:
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18553207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64185531Medicaid
000000044261OtherBCBS PROVIDER NUMBER
KY18553OtherLICENSE
C24957Medicare UPIN
0375239Medicare PIN
0374639Medicare PIN
KY18553OtherLICENSE
0375020Medicare PIN
KY00280132Medicare PIN
0375139Medicare PIN
0375338Medicare PIN
KY64185531Medicaid
0525639Medicare PIN
0374579Medicare PIN