NPIMap

Organization Active NPI

Magnolia Family Clinic

  • Family Medicine Physician
  • Rienzi, MS
National Provider Identifier
1508303348
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MAGNOLIA FAMILY CLINIC
Practice address
82 Main St
Rienzi, MS 38865-9144
Phone
(662) 293-6699
Fax
(662) 293-6698
NPI assigned
Jan 31, 2017
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MAGNOLIA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mrs. Deonne Henry
Title
Executive Director
Phone
(662) 293-1076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

82 Main St
Rienzi, MS 38865-9144

Mailing address

401 Alcorn Dr Ste 2C
Corinth, MS 38834-9073
Phone (662) 293-7618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170418000447 MS Part B Supplier - Clinic/Group Practice 3072899541 Receives reassigned benefits from 5 practitioners
Practice locations: Rienzi, MS

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Family Clinic2 organizations share this tax ID, including this one
Part of
Magnolia Regionl Health

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1508303348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ALCORN DR STE 2C",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349073",
            "telephone_number": "662-293-7618",
            "fax_number": "662-293-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MAIN ST",
            "city": "RIENZI",
            "state": "MS",
            "postal_code": "388659144",
            "telephone_number": "662-293-6699",
            "fax_number": "662-293-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA FAMILY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA REGIONAL HEALTH CENTER",
        "enumeration_date": "2017-01-31",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEONNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-293-1076",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rienzi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.