NPIMap

Organization Active NPI

Magnolia Endoscopy Center, LLC

  • Endoscopy Clinic/Center
  • Corinth, MS
National Provider Identifier
1740264274
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
Legal business name
MAGNOLIA ENDOSCOPY CENTER, LLC
Practice address
3050 Corder Dr
Corinth, MS 38834-6210
Phone
(662) 284-9902
Fax
(662) 284-9904
NPI assigned
Nov 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Authorized official

Name
Dr. Fredrick Alvin Corder, M.D.
Title
Owner/Physician/Medical Director
Phone
(662) 284-9902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X Primary

Addresses

Primary practice location

3050 Corder Dr
Corinth, MS 38834-6210

Mailing address

PO Box 600
Corinth, MS 38835-0600
Phone (662) 284-9902

Other identifiers 1

IdentifierTypeStateIssuer
00770615MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111216000299 MS Part B Supplier - Ambulatory Surgical Center 1052586211 Practice locations: Corinth, MS

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Magnolia Endoscopy Center LLCCCN 25C0001043
Medicare certification status
ActiveFrom the Provider of Services file

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1005167Magnolia Endoscopy Center LLC3050 Corder Drive, Corinth, MS 38834Certificate of waiverOct 15, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473292800000",
    "number": "1740264274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388350600",
            "telephone_number": "662-284-9902",
            "fax_number": "662-284-9904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 CORDER DR",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388346210",
            "telephone_number": "662-284-9902",
            "fax_number": "662-284-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2016-09-08",
        "status": "A",
        "authorized_official_last_name": "CORDER",
        "authorized_official_first_name": "FREDRICK",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "662-284-9902",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770615",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; 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.