Provider Demographics
NPI:1457662595
Name:MAGNOLIA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL MEDICAL CENTER
Other - Org Name:MRMC WOUND CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-235-3211
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:870-235-3600
Mailing Address - Fax:870-235-3647
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2415
Practice Address - Country:US
Practice Address - Phone:870-235-3600
Practice Address - Fax:870-235-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4638208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty