Provider Demographics
NPI:1225220437
Name:MAGNOLIA MEDICAL SUPPLIES AND EQUIPMENT
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL SUPPLIES AND EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-301-1013
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-0085
Mailing Address - Country:US
Mailing Address - Phone:662-301-1013
Mailing Address - Fax:662-357-7621
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2146
Practice Address - Country:US
Practice Address - Phone:662-301-1013
Practice Address - Fax:662-301-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies