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Contact Information

MAGNOLIA PEDIATRIC CLINIC, INC.
306 E MCNEIL
MAGNOLIA, AR71753-2927
 Phone: 870-234-5171
 Fax: 870-234-0507
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MAGNOLIA PEDIATRIC CLINIC, INC.

NPI Number 1396775797
LBN Legal business name MAGNOLIA PEDIATRIC CLINIC, INC.
Authorized official AMY CROSS - (OWNER/PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/03/2006
Last updated 02/20/2012 - About 14 years ago
Identifiers
AR License # E2147
AR Medicaid 140579002
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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