Healthcare Provider Details

I. General information

NPI: 1033475165
Provider Name (Legal Business Name): MAGNOLIA URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HIGHWAY 49 STE B
WIGGINS MS
39577-8012
US

IV. Provider business mailing address

2201 HIGHWAY 49 STE B
WIGGINS MS
39577-8012
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-2798
  • Fax: 601-928-2790
Mailing address:
  • Phone: 601-928-2798
  • Fax: 601-928-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CLIFFORD EUGENE BAKER
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 601-928-2798