Provider Demographics
NPI:1376220814
Name:MAGNOLIA PLASTIC SURGERY & MEDSPA
Entity type:Organization
Organization Name:MAGNOLIA PLASTIC SURGERY & MEDSPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARVET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-621-8934
Mailing Address - Street 1:4500 MAGAZINE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1543
Mailing Address - Country:US
Mailing Address - Phone:504-571-5908
Mailing Address - Fax:504-571-5953
Practice Address - Street 1:4500 MAGAZINE ST STE 1
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-1575
Practice Address - Country:US
Practice Address - Phone:504-608-7863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty