Provider Demographics
NPI:1770882805
Name:MAGNOLIA HEALTH SYSTEMS
Entity type:Organization
Organization Name:MAGNOLIA HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-731-4555
Mailing Address - Street 1:PO BOX 4542
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-4542
Mailing Address - Country:US
Mailing Address - Phone:903-731-4555
Mailing Address - Fax:903-731-4699
Practice Address - Street 1:3201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6901
Practice Address - Country:US
Practice Address - Phone:903-727-2948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty