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General NPI Number Information
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NPI Number | 1902733652
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Entity Type | Organization
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Legal Business Name | OLD MISSION ADVANCED CARE, PLLC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 148 E FRONT ST STE 301
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-5726
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Country | US
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Telephone | 231-333-4388
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Fax | 231-525-2081
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Provider Business Mailing Address
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Address Line | 148 E FRONT ST STE 301
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-5726
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Country | US
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Telephone | 231-333-4388
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Fax | 231-525-2081
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Authorized Official
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Title or Position | OWNER. CEO
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Name | CHRISTOPHER MASON
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Credential | DO
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Telephone | 231-333-4388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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