Mesos, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

606400892 Issued in FL

Legal business name

MESOS, LLC

Practice address

757 County Road 466
Lady Lake, FL 32159-6340

Phone

(352) 259-8599

Fax

(352) 259-8559

NPI assigned

Mar 29, 2012

Last updated

Mar 29, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry Wayne Blevins, PA

Title

Ceo

Phone

(352) 259-8599

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332979200000",
    "number": "1033485578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 COUNTY ROAD 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596340",
            "telephone_number": "352-259-8599",
            "fax_number": "352-259-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 COUNTY ROAD 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596340",
            "telephone_number": "352-259-8599",
            "fax_number": "352-259-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESOS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-29",
        "last_updated": "2012-03-29",
        "status": "A",
        "authorized_official_last_name": "BLEVINS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-259-8599",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "606400892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.