Provider Demographics
NPI:1417642224
Name:FIRST ASCENT BIOMEDICAL
Entity Type:Organization
Organization Name:FIRST ASCENT BIOMEDICAL
Other - Org Name:FIRST ASCENT BIO
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-281-1620
Mailing Address - Street 1:1421 SW 107TH AVE # 427
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2526
Mailing Address - Country:US
Mailing Address - Phone:248-703-3927
Mailing Address - Fax:
Practice Address - Street 1:1421 SW 107TH AVE # 427
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2526
Practice Address - Country:US
Practice Address - Phone:248-703-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory