Provider Demographics
NPI:1295856755
Name:MAGEE BENEVOENT ASSOCIATION
Entity Type:Organization
Organization Name:MAGEE BENEVOENT ASSOCIATION
Other - Org Name:MAGEE GENERAL HOSPITAL CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:601-849-7371
Mailing Address - Street 1:300 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3665
Mailing Address - Country:US
Mailing Address - Phone:601-849-5070
Mailing Address - Fax:601-849-7116
Practice Address - Street 1:300 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3665
Practice Address - Country:US
Practice Address - Phone:601-849-5070
Practice Address - Fax:601-849-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13-274282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013205Medicaid
MS09013205Medicaid