Provider Demographics
NPI:1093053571
Name:ASCENDA BIOSCIENCES, LLC
Entity Type:Organization
Organization Name:ASCENDA BIOSCIENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-580-0613
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-0589
Mailing Address - Country:US
Mailing Address - Phone:678-580-0613
Mailing Address - Fax:678-580-0613
Practice Address - Street 1:2001 WESTSIDE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-580-0613
Practice Address - Fax:470-375-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL170450Medicaid
MS00858259Medicaid
MD4946006Medicaid
GA003145374AMedicaid
VA1093053571Medicaid
NC291U00000XMedicaid