Magnolia Diagonstic Services Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MAGNOLIA DIAGONSTIC SERVICES INC.

Practice address

2005 Creswell Ave
Shreveport, LA 71104-2201

Phone

(318) 678-0709

NPI assigned

Jun 17, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Dewarrent L. Brantley

Title

Ceo/ President

Phone

(318) 678-0709

Specialties & licenses 1

Addresses

Other names 1

• no Former legal business name

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1821225806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-678-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-678-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DIAGONSTIC SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-17",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "DEWARRENT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO/ PRESIDENT",
        "authorized_official_telephone_number": "318-678-0709",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "no",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Christopher Micheal Magill, PA-C
• Nan Magness, LPC
• Magnolia Community Mental Health Facility Inc.
• Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.
• Magnolia Diagnostic Services Inc.
• Magnolia Durable Medical Equipment Inc.
• Magnolia Family Support & Interventions, LLC
• Magnolia Intergrated Healthcare Services Inc
• Magnolia Manor Nursing & Rehab CNTR LLC (Magnolia Manor Nursing & Rehabilitation Center)
• Magnolia Medical Internal Medicine Inc

• Multi-Specialty Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Multi-Specialty Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; 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.