Provider Demographics
NPI:1659655652
Name:MISSION HOSPITAL INC
Entity Type:Organization
Organization Name:MISSION HOSPITAL INC
Other - Org Name:MISSION PHARMACY - CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILCORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-213-0068
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4550
Mailing Address - Country:US
Mailing Address - Phone:828-213-2950
Mailing Address - Fax:828-213-2951
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-213-2950
Practice Address - Fax:828-213-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11071332B00000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3459357OtherNCPDP PROVIDER IDENTIFICATION NUMBER