Provider Demographics
NPI:1013554773
Name:MAGNOLIA TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MAGNOLIA TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-461-9659
Mailing Address - Street 1:2913 BRIERWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2946
Mailing Address - Country:US
Mailing Address - Phone:804-461-9659
Mailing Address - Fax:804-722-3647
Practice Address - Street 1:2913 BRIERWOOD ROAD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2946
Practice Address - Country:US
Practice Address - Phone:804-461-9659
Practice Address - Fax:804-722-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)