Magnolia Grove Healthcare

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

12792 Issued in MS

Legal business name

MAGNOLIA GROVE HEALTHCARE

Practice address

4333 15TH St Ste a
Gulfport, MS 39501-2525

Phone

(228) 863-4000

Fax

(228) 863-4003

NPI assigned

Aug 16, 2007

Organization subpart

No

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

Authorized official

Name

Tracey Decena

Title

Office Manager

Phone

(228) 863-4000

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaizad P Tamboli, M.D.

  • Internal Medicine Physician
  • St Petersburg, FL
  • NPI 1881753986
  NPD (past)

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1710179395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1040",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021040",
            "telephone_number": "228-863-4000",
            "fax_number": "228-863-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4333 15TH ST STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012525",
            "telephone_number": "228-863-4000",
            "fax_number": "228-863-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA GROVE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "DECENA",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "228-863-4000"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "12792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Kyle Madigan, LCSW
• Angela Faye Magee, LMT
• Natasha Magee
• Rachel C Magee
• Autumn Maghupoy
• Magnolia Mental Health and Wellness PLLC
• Lauren Mahan
• Brian Doyal Maher, MD
• Brittney Mahoney, OT
• Leonard Raymond Maiolatesi Jr.

• Primary Care Clinic/Center in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.