Provider Demographics
NPI:1881015675
Name:MISSION HOSPITALS, INC.
Entity Type:Organization
Organization Name:MISSION HOSPITALS, INC.
Other - Org Name:FULLERTON GENETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-213-0499
Mailing Address - Street 1:PO BOX 15268
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-0268
Mailing Address - Country:US
Mailing Address - Phone:828-250-2833
Mailing Address - Fax:828-250-2932
Practice Address - Street 1:186 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 501
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5275
Practice Address - Country:US
Practice Address - Phone:828-856-5594
Practice Address - Fax:828-681-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2351535EMedicare PIN