NPIMap

Organization Active NPI

Magnolia Intergrated Healthcare Services Inc

  • Clinic Pharmacy
  • Shreveport, LA
National Provider Identifier
1972730828
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
MAGNOLIA INTERGRATED HEALTHCARE SERVICES INC
Practice address
2005 Creswell Ave
Shreveport, LA 71104-2201
Phone
(318) 678-0709
NPI assigned
Jun 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

2005 Creswell Ave
Shreveport, LA 71104-2201

Mailing address

2005 Creswell Ave
Shreveport, LA 71104-2201
Phone (318) 678-0709

Other names 1

  • NO Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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": "1972730828",
    "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 INTERGRATED HEALTHCARE SERVICES 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": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NO",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • 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.