Provider Demographics
NPI:1578666756
Name:MAGNOLIA FIRST FAMILY MEDICINE P.A.
Entity Type:Organization
Organization Name:MAGNOLIA FIRST FAMILY MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-5450
Mailing Address - Street 1:2200 SOUTHWEST FWY
Mailing Address - Street 2:SUITE333
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4710
Mailing Address - Country:US
Mailing Address - Phone:713-520-5450
Mailing Address - Fax:713-520-5458
Practice Address - Street 1:2200 SOUTHWEST FWY
Practice Address - Street 2:SUITE333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4710
Practice Address - Country:US
Practice Address - Phone:713-520-5450
Practice Address - Fax:713-520-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169962101Medicaid
TX169962101Medicaid
TXI22142Medicare UPIN