Healthcare Provider Details

I. General information

NPI: 1427392042
Provider Name (Legal Business Name): MISSION HOSPITALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HOSPITAL DR
CLYDE NC
28721-0107
US

IV. Provider business mailing address

PO BOX 602811
CHARLOTTE NC
28260-2811
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-7776
  • Fax: 828-274-5134
Mailing address:
  • Phone: 828-255-7776
  • Fax: 828-274-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM R HATHAWAY
Title or Position: CMO
Credential: MD
Phone: 828-213-0499