| Freedom Hospital Of Magnolia Llc | |
|
205 N Cherry St Magnolia MS 39652-2819 | |
| (601) 783-2353 | |
| (601) 783-9003 |
| Full Name | Freedom Hospital Of Magnolia Llc |
|---|---|
| Speciality | General Practice |
| Location | 205 N Cherry St, Magnolia, Mississippi |
| Authorized Official Name and Position | Timothy Jason Reed (CEO) |
| Authorized Official Contact | 3378021336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Freedom Hospital Of Magnolia Llc 4815 Ihles Rd Lake Charles LA 70605-5900 Ph: (337) 802-1336 | Freedom Hospital Of Magnolia Llc 205 N Cherry St Magnolia MS 39652-2819 Ph: (601) 783-2353 |
| NPI Number | 1598212490 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/08/2016 |
| Medicare PECOS PAC ID | 4082910393 |
|---|---|
| Medicare Enrollment ID | O20170216001965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598212490 | NPI | - | NPPES |
| 20043 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lucius M Lampton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689781007 PECOS PAC ID: 0547221798 Enrollment ID: I20041021000705 |
| Provider Name | Betty G Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023067766 PECOS PAC ID: 5799818472 Enrollment ID: I20100802000439 |
| Provider Name | Tonya M Rushing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922653849 PECOS PAC ID: 9537592365 Enrollment ID: I20191209000561 |
| Provider Name | Alisa Britney Kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023635166 PECOS PAC ID: 0547675316 Enrollment ID: I20210209002610 |
| Provider Name | Chelsea Amanda Brooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770367716 PECOS PAC ID: 4082145172 Enrollment ID: I20240930003472 |
| Provider Name | John Douglas Nance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285205740 PECOS PAC ID: 8123422755 Enrollment ID: I20250210000861 |
Magnolia Clinic, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 111 Magnolia St, Magnolia, MS 39652 Phone: 601-783-0374 Fax: 601-783-5126 | |
Angel Wings Community Healthcare Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 215 Magnolia St, Magnolia, MS 39652 Phone: 601-869-0299 Fax: 601-680-3216 | |
Freedom Hospital Of Magnolia Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 120 E Myrtle St, Magnolia, MS 39652 Phone: 601-783-2353 Fax: 601-783-9003 | |
Freedom Hospital Of Magnolia, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 N Cherry St, Magnolia, MS 39652 Phone: 601-783-2353 Fax: 601-783-9003 |