Provider Demographics
NPI:1144046053
Name:MAGNOLIA PREMIER HEALTH, LLC
Entity type:Organization
Organization Name:MAGNOLIA PREMIER HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-464-8100
Mailing Address - Street 1:126 N COURT SQ STE 2
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-0400
Mailing Address - Country:US
Mailing Address - Phone:334-464-8100
Mailing Address - Fax:334-323-7779
Practice Address - Street 1:126 N COURT SQ STE 2
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0400
Practice Address - Country:US
Practice Address - Phone:334-464-8100
Practice Address - Fax:334-323-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty