Provider Demographics
NPI:1801131479
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 / COO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGGARD GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-250-2833
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: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:828-586-5594
Practice Address - Fax:828-250-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty