Basic Information
| Provider Information | |||||||||
| NPI: | 1477812345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION MEDICAL ASSOCIATES INC | ||||||||
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| OtherOrganizationName: | MYCAREPLUS - CANDLER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282502833 | ||||||||
| FaxNumber: | 8282502740 | ||||||||
| Practice Location | |||||||||
| Address1: | 1388 SAND HILL ROAD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282135335 | ||||||||
| FaxNumber: | 8282135336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | SINK | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP - AMBULATORY/ANCILLARY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8282138212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.