Provider Demographics
NPI:1205476702
Name:MAGNOLIA MEDICAL, LLC
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-615-8693
Mailing Address - Street 1:304 HIGHLAND BLVD STE B
Mailing Address - Street 2:
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 1:300 HIGHLAND BLVD STE G
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4600
Practice Address - Country:US
Practice Address - Phone:601-442-6493
Practice Address - Fax:601-445-0999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier