Healthcare Provider Details

I. General information

NPI: 1104303502
Provider Name (Legal Business Name): ASCENTIUM HEALTHCARE RESOURCES I INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIONEER WAY
MAGEE MS
39111-5501
US

IV. Provider business mailing address

100 PIONEER WAY
MAGEE MS
39111-5501
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-6440
  • Fax: 601-849-1332
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEE
Title or Position: COB
Credential: MD
Phone: 601-849-6440