Provider Demographics
NPI:1003491234
Name:MAGNOLIA REGIONAL HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL HEALTH SYSTEM INC
Other - Org Name:MAGNOLIA ORTHOPEDIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-235-3212
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-0629
Mailing Address - Country:US
Mailing Address - Phone:870-235-3212
Mailing Address - Fax:
Practice Address - Street 1:1005 N JACKSON STE B
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2447
Practice Address - Country:US
Practice Address - Phone:870-235-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty