Provider Demographics
NPI:1245410398
Name:MAGNOLIA REGIONAL HEALTH CENTER - CRNA SERVICES
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL HEALTH CENTER - CRNA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-287-6913
Mailing Address - Street 1:P.O. BOX 1818
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-1818
Mailing Address - Country:US
Mailing Address - Phone:662-293-1000
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9368
Practice Address - Country:US
Practice Address - Phone:662-293-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013277Medicaid
MS09013277Medicaid