Provider Demographics
NPI:1679366959
Name:SOUTHERN MAGNOLIA ENTERPRISE LLC
Entity type:Organization
Organization Name:SOUTHERN MAGNOLIA ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-644-6334
Mailing Address - Street 1:613 FLEURIE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1117
Mailing Address - Country:US
Mailing Address - Phone:504-644-6334
Mailing Address - Fax:
Practice Address - Street 1:613 FLEURIE DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1117
Practice Address - Country:US
Practice Address - Phone:504-644-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies