Magnolia Durable Medical Equipment Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MAGNOLIA DURABLE MEDICAL EQUIPMENT INC.

Practice address

2005 Creswell Street
Shreveport, LA 71104-2201

Phone

(318) 678-0907

NPI assigned

Jun 18, 2009

Last updated

Jun 18, 2009By 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

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": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1841427788",
    "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 STREET",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-678-0907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DURABLE MEDICAL EQUIPMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2009-06-18",
        "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": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "no",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nan Magness, LPC
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• Magnolia Intergrated Healthcare Services Inc
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• Magnolia Medical Internal Medicine Inc
• Magnolia Medical LLC

• Prosthetic/Orthotic Supplier in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Prosthetic/Orthotic Supplier in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.