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General NPI Number Information
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NPI Number | 1982136123
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Entity Type | Organization
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Legal Business Name | MISSION MEDICAL, INC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 124 JACKSON AVE S STE C
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2232
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Country | US
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Telephone | 256-398-7212
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Fax | 256-398-7213
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Provider Business Mailing Address
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Address Line | 124 JACKSON AVE S STE C
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2232
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Country | US
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Telephone | 256-398-7212
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Fax | 256-398-7213
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROLEE COSBY
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Credential |
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Telephone | 256-857-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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