Provider Demographics
NPI:1124482617
Name:MAGNOLIA MEDICAL LLC
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-334-2599
Mailing Address - Street 1:304 HIGHLAND BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4624
Mailing Address - Country:US
Mailing Address - Phone:601-442-6493
Mailing Address - Fax:601-445-0999
Practice Address - Street 1:1950 E 70TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5345
Practice Address - Country:US
Practice Address - Phone:318-219-5219
Practice Address - Fax:888-542-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies