Provider Demographics
NPI:1780665547
Name:MAGNOLIA ANESTHESIOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MAGNOLIA ANESTHESIOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-665-0457
Mailing Address - Street 1:PO BOX 24023
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4023
Mailing Address - Country:US
Mailing Address - Phone:622-662-6650
Mailing Address - Fax:622-665-0458
Practice Address - Street 1:401 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9067
Practice Address - Country:US
Practice Address - Phone:662-665-0457
Practice Address - Fax:662-665-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015115Medicaid
MSC02349Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER