NPIMap

Organization Active NPI

Magnolia Clinic

  • Clinic/Center
  • Meridian, MS
National Provider Identifier
1093038234
Registry record updated Mar 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
31 136 Issued in MS
Legal business name
MAGNOLIA CLINIC
Practice address
4555 Highland Park Dr
Meridian, MS 39307-5429
Phone
(601) 481-1135
Fax
(601) 581-7676
NPI assigned
Mar 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles Carlisle, MPPA
Title
Director
Phone
(601) 581-7836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 31 136 MS Primary

Addresses

Primary practice location

4555 Highland Park Dr
Meridian, MS 39307-5429

Mailing address

P O Box 4128, West Station
4555 Highland Park Drive
Meridian,, MS 39304-4128
Phone (601) 481-1135

Other names 1

  • EAST MS STATE HOSPITAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Ms State Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1093038234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 4128, WEST STATION",
            "address_2": "4555 HIGHLAND PARK DRIVE",
            "city": "MERIDIAN,",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-481-1135",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 HIGHLAND PARK DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075429",
            "telephone_number": "601-481-1135",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-581-7836",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPPA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "31 136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAST MS STATE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.