Provider Demographics
NPI:1871509521
Name:MISSION HOSPITAL INC
Entity Type:Organization
Organization Name:MISSION HOSPITAL INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, ANCILLARY AND SUPPO
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-213-1132
Mailing Address - Street 1:509 BILTMORE AVE
Mailing Address - Street 2:A158
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4601
Mailing Address - Country:US
Mailing Address - Phone:828-213-0050
Mailing Address - Fax:828-213-0054
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:A158
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-0050
Practice Address - Fax:828-213-0054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC045313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC116061Medicaid
3422742OtherNCPDP
3422742OtherNCPDP PROVIDER IDENTIFICATION NUMBER