Provider Demographics
NPI:1558902544
Name:MAGNOLIA MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-613-6822
Mailing Address - Street 1:102 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3250
Mailing Address - Country:US
Mailing Address - Phone:662-834-1721
Mailing Address - Fax:662-834-1721
Practice Address - Street 1:102 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3250
Practice Address - Country:US
Practice Address - Phone:662-834-1721
Practice Address - Fax:662-834-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies