Provider Demographics
NPI:1790126431
Name:MISSION HEALTH CONCEPTS, INC
Entity Type:Organization
Organization Name:MISSION HEALTH CONCEPTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-427-0380
Mailing Address - Street 1:215 MUSHROOM BLVD BLDG 18
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3256
Mailing Address - Country:US
Mailing Address - Phone:585-427-0380
Mailing Address - Fax:585-427-2604
Practice Address - Street 1:215 MUSHROOM BLVD BLDG 18
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3256
Practice Address - Country:US
Practice Address - Phone:585-427-0380
Practice Address - Fax:585-427-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies