Provider Demographics
NPI:1487819934
Name:MAGEE BENEVOLENT ASSOCIATION D/B/A MAGEE GENERAL HOSPITAL
Entity type:Organization
Organization Name:MAGEE BENEVOLENT ASSOCIATION D/B/A MAGEE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRUMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-849-5070
Mailing Address - Street 1:376A SIMPSON HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3409
Mailing Address - Country:US
Mailing Address - Phone:601-849-5321
Mailing Address - Fax:601-849-7205
Practice Address - Street 1:376A SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3409
Practice Address - Country:US
Practice Address - Phone:601-849-5321
Practice Address - Fax:601-849-7205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGEE BENEVOLENT ASSN D/B/A MAGEE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00024363AM0700X
MSR678562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty