Provider Demographics
NPI:1679985295
Name:MAGNOLIA MEDICAL
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-334-2599
Mailing Address - Street 1:8261 SUMMA AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3452
Mailing Address - Country:US
Mailing Address - Phone:225-752-7088
Mailing Address - Fax:225-448-2880
Practice Address - Street 1:7516 BLUEBONNET BLVD
Practice Address - Street 2:BOX 434
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1627
Practice Address - Country:US
Practice Address - Phone:225-752-7088
Practice Address - Fax:225-448-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies