=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871888271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGEE BENEVOLENT ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2011
-----------------------------------------------------
Last Update Date | 06/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 EATON STREET
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-785-6786
-----------------------------------------------------
Fax | 601-785-7929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 EATON STREET
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-785-6786
-----------------------------------------------------
Fax | 601-785-7929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ALTHEA H CRUMPTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-849-7245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------