Provider Demographics
NPI:1639482847
Name:MISSION MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:MISSION MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:WESTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-250-2988
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-250-2833
Mailing Address - Fax:
Practice Address - Street 1:2585 HENDERSONVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9577
Practice Address - Country:US
Practice Address - Phone:828-687-8647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty