Provider Demographics
NPI:1952736712
Name:MISSION MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MISSION MEDICAL ASSOCIATES, INC.
Other - Org Name:MISSION INFECTIOUS DISEASE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGGARD GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-213-9637
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:828-651-6474
Mailing Address - Fax:
Practice Address - Street 1:900 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1734
Practice Address - Country:US
Practice Address - Phone:828-258-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347819BMedicare PIN