Healthcare Provider Details

I. General information

NPI: 1528560281
Provider Name (Legal Business Name): VENTURE HOSPITALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 8TH AVE SW
MAGEE MS
39111-3967
US

IV. Provider business mailing address

PO BOX 785
MAGEE MS
39111-0785
US

V. Phone/Fax

Practice location:
  • Phone: 601-955-1977
  • Fax:
Mailing address:
  • Phone: 601-955-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM MCNULTY
Title or Position: DIRECTOR
Credential:
Phone: 601-955-1977