Provider Demographics
NPI:1962279711
Name:MAGNOLIA STATE ANESTHESIA SERVICES, PLLC
Entity type:Organization
Organization Name:MAGNOLIA STATE ANESTHESIA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:SSN
Authorized Official - Last Name:TOMAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-530-3899
Mailing Address - Street 1:7956 VAUGHN RD STE 165
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6819
Mailing Address - Country:US
Mailing Address - Phone:228-202-1006
Mailing Address - Fax:
Practice Address - Street 1:2406 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1813
Practice Address - Country:US
Practice Address - Phone:228-202-1006
Practice Address - Fax:334-239-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty