Basic Information
| Provider Information | |||||||||
| NPI: | 1255752721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION MEDICAL ASSOCIATES, INC | ||||||||
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| OtherOrganizationName: | ASHEVILLE CARDIOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602381 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286811536 | ||||||||
| FaxNumber: | 8282254639 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 W PARKER RD | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286554673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286595777 | ||||||||
| FaxNumber: | 8282746005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2013 | ||||||||
| LastUpdateDate: | 12/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOGGARD-GREEN | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8282130193 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MISSION MEDICAL ASSOCIATES, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.