| Magnolia Clinic, Inc. | |
|
111 Magnolia St Magnolia MS 39652-2825 | |
| (601) 783-0374 | |
| (601) 783-5126 |
| Full Name | Magnolia Clinic, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 111 Magnolia St, Magnolia, Mississippi |
| Authorized Official Name and Position | Patsy A. Geller (CLINIC MANAGER) |
| Authorized Official Contact | 6017830374 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Clinic, Inc. 111 Magnolia St Magnolia MS 39652-2825 Ph: (601) 783-0374 | Magnolia Clinic, Inc. 111 Magnolia St Magnolia MS 39652-2825 Ph: (601) 783-0374 |
| NPI Number | 1033226436 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0840229654 |
|---|---|
| Medicare Enrollment ID | O20050811000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033226436 | NPI | - | NPPES |
| 9013142 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (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 | Chelsea K Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235646688 PECOS PAC ID: 6800157546 Enrollment ID: I20180221000910 |
| Provider Name | Lindsey J Nobles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154901445 PECOS PAC ID: 5597167684 Enrollment ID: I20210825002595 |
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