1093053571 NPI number — ASCENDA BIOSCIENCES, LLC

Table of content: (NPI 1093053571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093053571 NPI number — ASCENDA BIOSCIENCES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENDA BIOSCIENCES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093053571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUDERTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18964-0589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-580-0613
Provider Business Mailing Address Fax Number:
678-580-0613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 WESTSIDE PKWY STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-580-0613
Provider Business Practice Location Address Fax Number:
470-375-3701
Provider Enumeration Date:
01/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
678-580-0613

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 170450 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00858259 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4946006 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003145374A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093053571 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 291U00000X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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