Provider Demographics
NPI:1568083491
Name:MAGNOLIA REGIONAL HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL HEALTH SYSTEM INC
Other - Org Name:MAGNOLIA SURGICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-235-3212
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:
Practice Address - Street 1:1005 N JACKSON STE C
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2447
Practice Address - Country:US
Practice Address - Phone:870-235-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA REGIONAL HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-01
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty