Provider Demographics
NPI:1902565906
Name:MAGNOLIA MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-407-2823
Mailing Address - Street 1:1410 14TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4202
Mailing Address - Country:US
Mailing Address - Phone:888-407-2823
Mailing Address - Fax:888-435-9197
Practice Address - Street 1:1410 14TH ST STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4202
Practice Address - Country:US
Practice Address - Phone:888-407-2823
Practice Address - Fax:888-435-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty