Provider Demographics
NPI:1982136123
Name:MISSION MEDICAL, INC
Entity type:Organization
Organization Name:MISSION MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-857-1223
Mailing Address - Street 1:124 JACKSON AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2232
Mailing Address - Country:US
Mailing Address - Phone:256-398-7212
Mailing Address - Fax:256-398-7213
Practice Address - Street 1:124 JACKSON AVE S STE C
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2232
Practice Address - Country:US
Practice Address - Phone:256-398-7212
Practice Address - Fax:256-398-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty