Provider Demographics
NPI:1790220846
Name:MAGNIFICAT MEDICAL SERVICE PLLC
Entity Type:Organization
Organization Name:MAGNIFICAT MEDICAL SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-381-3807
Mailing Address - Street 1:17833 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8112
Mailing Address - Country:US
Mailing Address - Phone:507-381-3807
Mailing Address - Fax:
Practice Address - Street 1:17833 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8112
Practice Address - Country:US
Practice Address - Phone:507-381-3807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2096146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty