NPIMap

Organization Active NPI

Magnolia Specialty Clinic

  • Neurology Physician
  • Corinth, MS
National Provider Identifier
1881959401
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
MAGNOLIA SPECIALTY CLINIC
Practice address
3704 Hwy. 72 West
Corinth, MS 38834-8556
Phone
(662) 665-8041
Fax
(662) 665-8049
NPI assigned
Jul 10, 2012
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MAGNOLIA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Mr. Howard Nelson
Title
VP Physician Services
Phone
(662) 293-7618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3704 Hwy. 72 West
Corinth, MS 38834-8556

Mailing address

P.O. Box 2040
Corinth, MS 38835-2040
Phone (662) 665-8041

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121127000091 MS Part B Supplier - Clinic/Group Practice 5193976025 Receives reassigned benefits from 4 practitioners
Practice locations: Booneville, MS; Corinth, MS

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Specialty Clinic2 organizations share this tax ID, including this one
Part of
Magnolia Regionl Health

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1881959401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2040",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388352040",
            "telephone_number": "662-665-8041",
            "fax_number": "662-665-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 HWY. 72 WEST",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388348556",
            "telephone_number": "662-665-8041",
            "fax_number": "662-665-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA SPECIALTY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA REGIONAL HEALTH CENTER",
        "enumeration_date": "2012-07-10",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "662-293-7618",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.