Provider Demographics
NPI:1932886330
Name:MAGIS LLC
Entity Type:Organization
Organization Name:MAGIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HERDZINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-810-6822
Mailing Address - Street 1:540 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2215
Mailing Address - Country:US
Mailing Address - Phone:405-810-6822
Mailing Address - Fax:405-810-6824
Practice Address - Street 1:540 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2215
Practice Address - Country:US
Practice Address - Phone:405-810-6822
Practice Address - Fax:405-810-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGeneticsGroup - Single Specialty