Provider Demographics
NPI:1750264560
Name:1977 MESK MEDICAL GROUP
Entity type:Organization
Organization Name:1977 MESK MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-305-3791
Mailing Address - Street 1:2900 OAKLAND DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5278
Mailing Address - Country:US
Mailing Address - Phone:407-305-3791
Mailing Address - Fax:
Practice Address - Street 1:2900 OAKLAND DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5278
Practice Address - Country:US
Practice Address - Phone:315-569-5318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1977 MESK MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-29
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty