Provider Demographics
NPI:1205833985
Name:MISSION HOSPITAL, INC.
Entity Type:Organization
Organization Name:MISSION HOSPITAL, INC.
Other - Org Name:MISSION REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURROCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:956-323-9106
Mailing Address - Street 1:900 S BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6613
Mailing Address - Country:US
Mailing Address - Phone:956-323-9102
Mailing Address - Fax:956-323-1817
Practice Address - Street 1:900 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-323-9102
Practice Address - Fax:956-323-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000370282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1126799-01Medicaid
TX1126799-02Medicaid
TX1126799-02Medicaid