Provider Demographics
NPI:1871649046
Name:MAGNOLIA HEALTHCARE LLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTHCARE LLC
Other - Org Name:MAGNOLIA RESPIRATORY AND MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MEMBER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:352-812-9358
Mailing Address - Street 1:303 SE 17TH ST
Mailing Address - Street 2:309-108
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4421
Mailing Address - Country:US
Mailing Address - Phone:352-812-9358
Mailing Address - Fax:
Practice Address - Street 1:1540 SW 5TH AVE
Practice Address - Street 2:103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0600
Practice Address - Country:US
Practice Address - Phone:352-812-9358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5937610001Medicare NSC