Provider Demographics
NPI:1386452878
Name:MAGNOLIA WEIGHT LOSS LLC
Entity type:Organization
Organization Name:MAGNOLIA WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TURFITT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:228-229-9038
Mailing Address - Street 1:620 BLUE MEADOW RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2834
Mailing Address - Country:US
Mailing Address - Phone:228-229-9038
Mailing Address - Fax:
Practice Address - Street 1:620 BLUE MEADOW RD UNIT 101
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2834
Practice Address - Country:US
Practice Address - Phone:228-229-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service