Provider Demographics
NPI:1598918377
Name:MAGNOLIA HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MAGNOLIA HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-955-0086
Mailing Address - Street 1:201 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7825
Mailing Address - Country:US
Mailing Address - Phone:478-955-0086
Mailing Address - Fax:478-922-2425
Practice Address - Street 1:201 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7825
Practice Address - Country:US
Practice Address - Phone:478-955-0086
Practice Address - Fax:478-922-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies