Provider Demographics
NPI:1902121866
Name:MAGEE BENEVOLENT ASSN DBA PEDIATRIC CLINIC OF MAGEE
Entity Type:Organization
Organization Name:MAGEE BENEVOLENT ASSN DBA PEDIATRIC CLINIC OF MAGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EATMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-849-7215
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:601-849-7215
Mailing Address - Fax:601-849-7221
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:601-849-7215
Practice Address - Fax:601-849-7221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGEE BENEVOLENT ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty