MEDICARE: MAGIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QG0250X	Genetics Clinic/Center
3	247200000X	Other Technician

General Provider Information

NPI Number	:	1932886330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGIS LLC

Provider Business Mailing Address
First Line	:	540 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-2215
Country	:	US
Telephone Number	:	405-810-6822
Fax Number	:	405-810-6824

Provider Business Practice Location Address
First Line	:	540 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-2215
Country	:	US
Telephone Number	:	405-810-6822
Fax Number	:	405-810-6824

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOEL W HERDZINA
Credential	:
Telephone Number	:	405-810-6822

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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Directions to “MAGIS LLC ” Practice Location

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