Provider Demographics
NPI:1407188501
Name:MAGNOLIA REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:MAGNOLIA REGIONAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-293-7661
Mailing Address - Street 1:611 ALCRON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-293-1000
Mailing Address - Fax:662-293-4201
Practice Address - Street 1:611 ALCRON DRIVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-293-1000
Practice Address - Fax:662-293-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013279Medicaid
MSC00065Medicare Oscar/Certification