Provider Demographics
NPI:1821426958
Name:MAGNOLIA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-264-7712
Mailing Address - Street 1:163 TURTLE CREEK DR
Mailing Address - Street 2:STE 160
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1284
Mailing Address - Country:US
Mailing Address - Phone:601-264-7712
Mailing Address - Fax:855-293-4897
Practice Address - Street 1:163 TURTLE CREEK DR
Practice Address - Street 2:STE 160
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1284
Practice Address - Country:US
Practice Address - Phone:601-264-7712
Practice Address - Fax:855-293-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7053190001Medicare NSC