Healthcare Provider Details

I. General information

NPI: 1770025637
Provider Name (Legal Business Name): MISSION MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 BILTMORE AVE
ASHEVILLE NC
28801
US

IV. Provider business mailing address

PO BOX 602373
CHARLOTTE NC
28260-2373
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-5400
  • Fax: 828-213-5410
Mailing address:
  • Phone: 828-213-1500
  • Fax: 828-651-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA MILLER
Title or Position: VP REVENUE CYCLE OPERATION
Credential:
Phone: 828-651-4144