Healthcare Provider Details

I. General information

NPI: 1366774002
Provider Name (Legal Business Name): MAGNACARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SIROCCO CT
FALLING WATERS WV
25419-1490
US

IV. Provider business mailing address

44 SIROCCO CT
FALLING WATERS WV
25419-1490
US

V. Phone/Fax

Practice location:
  • Phone: 304-919-7353
  • Fax:
Mailing address:
  • Phone: 304-919-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY NICHOLAS LUNDY
Title or Position: OWNER
Credential:
Phone: 304-919-7353