Healthtrust Magnolia, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

HEALTHTRUST MAGNOLIA, LLC

Practice address

203 S 40TH Ave Ste B
Hattiesburg, MS 39402-1604

Phone

(601) 606-6366

NPI assigned

Nov 9, 2017

Organization subpart

No

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

Authorized official

Name

Shelley H Gendusa

Title

Managing Member

Phone

(601) 606-6366

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1144733361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17168",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394047168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S 40TH AVE STE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021604",
            "telephone_number": "601-606-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHTRUST MAGNOLIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "GENDUSA",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "601-606-6366"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.