Provider Demographics
NPI:1053608877
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
Authorized Official - Prefix:MS
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:828-213-8201
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:828-681-1575
Practice Address - Street 1:310 LONG SHOALS ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-0000
Practice Address - Country:US
Practice Address - Phone:828-274-6610
Practice Address - Fax:828-274-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347819BMedicare PIN