NPIMap

Organization Active NPI

Magnolia Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Baton Rouge, LA
National Provider Identifier
1689683351
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MAGNOLIA MEDICAL, LLC
Practice address
5412 Dijon Dr
Baton Rouge, LA 70808-4315
Phone
(225) 615-8693
Fax
(225) 448-2280
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. David Charles Hyde
Title
Managing Partner
Phone
(225) 763-1314

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 05828/11.1 MS
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5412 Dijon Dr
Baton Rouge, LA 70808-4315

Mailing address

304 Highland Blvd
Suite B
Natchez, MS 39120
Phone (601) 442-6493

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930017092 LA DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Oxygen & Equipment 6709091887 Practice locations: Baton Rouge, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Magnolia Medical LLC5412 Dijon Dr, Baton Rouge, LA 70808-4315(225) 615-8693 Contracture Treatment Devices: Dynamic Splint|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Osteogenesis Stimulators|Pneumatic Compression Devices and/or Supplies|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Pros… Accepts assignmentParticipating since Jan 1, 2006

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Medical LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689683351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 HIGHLAND BLVD",
            "address_2": "SUITE B",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "39120",
            "telephone_number": "601-442-6493",
            "fax_number": "601-445-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 DIJON DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084315",
            "telephone_number": "225-615-8693",
            "fax_number": "225-448-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "225-763-1314",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "05828/11.1",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.