Provider Demographics
NPI:1457706129
Name:MAGNUM HEALTH
Entity Type:Organization
Organization Name:MAGNUM HEALTH
Other - Org Name:MAGNUM RX
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-363-0500
Mailing Address - Street 1:100 CONGRESS AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4072
Mailing Address - Country:US
Mailing Address - Phone:512-370-4018
Mailing Address - Fax:800-651-3566
Practice Address - Street 1:100 CONGRESS AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4072
Practice Address - Country:US
Practice Address - Phone:512-370-4018
Practice Address - Fax:800-651-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1054470001Medicare NSC