Provider Demographics
NPI:1033475165
Name:MAGNOLIA URGENT CARE INC
Entity Type:Organization
Organization Name:MAGNOLIA URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-928-2798
Mailing Address - Street 1:2201 HIGHWAY 49 STE B
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-8012
Mailing Address - Country:US
Mailing Address - Phone:601-928-2798
Mailing Address - Fax:601-928-2790
Practice Address - Street 1:2201 HIGHWAY 49 STE B
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-8012
Practice Address - Country:US
Practice Address - Phone:601-928-2798
Practice Address - Fax:601-928-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care