Provider Demographics
NPI:1578034088
Name:MISSION MEDSTAFF, LLC
Entity Type:Organization
Organization Name:MISSION MEDSTAFF, LLC
Other - Org Name:MISSION MEDSTAFF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-0822
Mailing Address - Street 1:1233 W MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5213
Mailing Address - Country:US
Mailing Address - Phone:704-295-0822
Mailing Address - Fax:
Practice Address - Street 1:2302 W MEADOWVIEW RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3706
Practice Address - Country:US
Practice Address - Phone:336-268-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION MEDSTAFF, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-09
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418800Medicaid
NC6602032Medicaid