Magnolia Primary Care LLC

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

MAGNOLIA PRIMARY CARE LLC

Doing business as

Magnolia Primary Care LLC

Practice address

2101 S Ejido Ave
Laredo, TX 78046-6750

Phone

(956) 235-2973

NPI assigned

Jan 6, 2022

Last updated

Jan 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Claudia Carrillo

Title

Member

Phone

(956) 235-2973

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Magnolia Primary Care LLC Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1750042289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 S EJIDO AVE",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780466750",
            "telephone_number": "956-235-2973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 S EJIDO AVE",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780466750",
            "telephone_number": "956-235-2973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "956-235-2973"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804361405",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Laredo",
            "affiliation": "N",
            "endpointDescription": "Primary Business Location",
            "address_1": "2101 S Ejido Ave",
            "city": "Laredo",
            "state": "TX",
            "country_code": "US",
            "postal_code": "780466750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Magnolia Primary Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Personal Care Attendant in Laredo, TX
• Providers in Laredo, TX by specialty
• Personal Care Attendant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.