Provider Demographics
NPI:1306197900
Name:MISSION HOSPITAL, INC
Entity Type:Organization
Organization Name:MISSION HOSPITAL, INC
Other - Org Name:FULLERTON GENETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-213-0499
Mailing Address - Street 1:PO BOX 15268
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-0268
Mailing Address - Country:US
Mailing Address - Phone:828-250-2833
Mailing Address - Fax:828-250-2932
Practice Address - Street 1:288 S RIDGECREST AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2838
Practice Address - Country:US
Practice Address - Phone:828-286-5000
Practice Address - Fax:828-250-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty