Healthcare Provider Details

I. General information

NPI: 1184801201
Provider Name (Legal Business Name): MAGNOLIA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5803
US

IV. Provider business mailing address

997 S PALAFOX ST
PENSACOLA FL
32502-5977
US

V. Phone/Fax

Practice location:
  • Phone: 877-274-4683
  • Fax: 800-310-5665
Mailing address:
  • Phone: 850-434-6674
  • Fax: 850-434-9664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE L RIGGINS
Title or Position: COMPTROLLER
Credential:
Phone: 850-434-6674