Provider Demographics
NPI:1104303502
Name:ASCENTIUM HEALTHCARE RESOURCES I INC
Entity type:Organization
Organization Name:ASCENTIUM HEALTHCARE RESOURCES I INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COB
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-849-6440
Mailing Address - Street 1:100 PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-5501
Mailing Address - Country:US
Mailing Address - Phone:601-849-6440
Mailing Address - Fax:601-849-1332
Practice Address - Street 1:100 PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-5501
Practice Address - Country:US
Practice Address - Phone:601-849-6440
Practice Address - Fax:601-849-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty