Healthcare Provider Details

I. General information

NPI: 1457706129
Provider Name (Legal Business Name): MAGNUM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONGRESS AVE SUITE 2000
AUSTIN TX
78701-4072
US

IV. Provider business mailing address

100 CONGRESS AVE SUITE 2000
AUSTIN TX
78701-4072
US

V. Phone/Fax

Practice location:
  • Phone: 512-370-4018
  • Fax: 800-651-3566
Mailing address:
  • Phone: 512-370-4018
  • Fax: 800-651-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY NERON
Title or Position: ADMINISTRATION
Credential:
Phone: 228-363-0500