Healthcare Provider Details

I. General information

NPI: 1770882805
Provider Name (Legal Business Name): MAGNOLIA HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S LOOP 256
PALESTINE TX
75801-6901
US

IV. Provider business mailing address

PO BOX 4542
PALESTINE TX
75802-4542
US

V. Phone/Fax

Practice location:
  • Phone: 903-727-2948
  • Fax:
Mailing address:
  • Phone: 903-731-4555
  • Fax: 903-731-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEC B LAW
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 903-731-4555