Provider Demographics
NPI:1669005740
Name:MISSION HOSPITAL INC
Entity Type:Organization
Organization Name:MISSION HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:EDWARD
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:956-323-9106
Mailing Address - Fax:956-323-9102
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:956-323-9106
Practice Address - Fax:956-323-9102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy