Provider Demographics
NPI:1437364106
Name:MAGNUM MEDICAL, LLC
Entity Type:Organization
Organization Name:MAGNUM MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-456-7171
Mailing Address - Street 1:4323 DIVISION ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3183
Mailing Address - Country:US
Mailing Address - Phone:504-456-7176
Mailing Address - Fax:504-456-0223
Practice Address - Street 1:4323 DIVISION ST
Practice Address - Street 2:SUITE 209
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3183
Practice Address - Country:US
Practice Address - Phone:504-456-7176
Practice Address - Fax:504-456-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1670740Medicaid
LA=========0OtherBCBS
LA=========0OtherBCBS