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General NPI Number Information
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NPI Number | 1124482617
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEDICAL LLC
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 1950 E 70TH ST SUITE H
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City | SHREVEPORT
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State | LA
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Zip | 71105-5345
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Country | US
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Telephone | 318-219-5219
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Fax | 888-542-4810
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Provider Business Mailing Address
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Address Line | 304 HIGHLAND BLVD SUITE B
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City | NATCHEZ
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State | MS
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Zip | 39120-4624
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Country | US
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Telephone | 601-442-6493
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Fax | 601-445-0999
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | TINA R ALEXANDER
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Credential |
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Telephone | 601-334-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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