MAGNOLIA CLINIC (NPI# 1093038234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093038234 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA CLINIC |
| Other Organization Name | EAST MS STATE HOSPITAL |
| Practice Address |
4555 Highland Park Dr Meridian MS 39307-5429 |
| Mailing Address |
P O Box 4128, West Station 4555 Highland Park Drive Meridian MS 39304-4128 |
| Practice Telephone | 6014811135 |
| Practice Fax Number | 6015817676 |
| Mailing Telephone | 6014811135 |
| Mailing Fax Number | 6015817676 |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-03-02 |
| Authorized Official Name | MR. CHARLES CARLISLE (DIRECTOR) |
| Authorized Official Telephone | 6015817836 |
| Authorized Official Credential | MPPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 31 136 | MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| EAST MS STATE HOSPITAL | Doing Business As Name - Organization |
| Street Address |
4555 HIGHLAND PARK DR |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39307-5429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740349257 | Hermogenes V Thomas | General Practice | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2006-12-08 |
| 1609232123 | Vickie L Warren | Nurse Practitioner | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2016-01-13 |
| 1326458837 | Marcy Tingle | Pharmacist | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2014-05-06 |
| 1447660956 | Donald Mckay | Pharmacist | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2014-05-06 |
| 1356689640 | Angela Marshon Mars | Counselor | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2013-01-22 |
| 1891059184 | Curtis Lee Jones | Social Worker | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2012-07-02 |
| 1558679902 | Physician Group | Clinic/Center | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-09-20 |
| 1649587460 | Stella Elizabeth Gervin-ward | Social Worker | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-09-01 |
| 1629394853 | East Mississippi State Hospital | Nursing Facility/Intermediate Care Facility | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-04-13 |
| 1235373663 | Kim Elliot Nagel | Psychiatry & Neurology | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2009-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841824232 | Erica Sheree Smith | Registered Nurse | 1818 College Dr, Meridian, MS 39307 | 2020-02-25 |
| 1518481480 | Derrick Pringle | Social Worker | 110 48th Ave, Meridian, MS 39307 | 2017-08-01 |
| 1821519547 | Leslie Rutkowski | Student in an Organized Health Care Education/Training Program | 2514 67th Avenue Loop Suite 112, Meridian, MS 39307 | 2017-07-03 |
| 1811254931 | Meridian Community College | Dentist | 910 Highway 19 North, Meridian, MS 39307 | 2012-04-13 |
| 1548533672 | Carvan Lorraine Carter | Counselor | 1807 39th Pl, Meridian, MS 39307 | 2012-02-21 |
| 1699921148 | Sara B Smith | Counselor | 1415 College Drive, Meridian, MS 39307 | 2008-08-15 |
| 1285856112 | Jan Parr Boggs | Psychologist | 1508 37th Avenue, Meridian, MS 39307 | 2007-05-02 |
| 1720694029 | Michelle Gomez Dickerson | Registered Nurse | 1818 College Drive, Meridian, MS 39307 | 2020-09-22 |
| 1770116030 | Briana Shanee Brunson | Nurse Practitioner | 1818 College Drive, Meridian, MS 39307 | 2020-02-14 |
| 1619507407 | Brenda A Thompson | Nurse Practitioner | 1818 College Drive, Meridian, MS 39307 | 2020-01-21 |
| Find all providers in zip 39307 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437788908 | Wellness Center | Clinic/Center | 1727 6th St, Meridian, MS 39301-5249 | 2020-04-06 |
| 1790284693 | The Clarkdale Clinic, LLC | Clinic/Center | 6905 Highway 145 S, Meridian, MS 39301-9771 | 2018-02-06 |
| 1952739229 | Meridian Weight Management Center | Clinic/Center | 1715 23rd Ave, Meridian, MS 39301-3104 | 2013-10-24 |
| 1750512877 | Marianne Zakarian, M.d., P.C. | Clinic/Center | 2536 N Stokesberry Pl, Meridian, ID 83646-1144 | 2009-08-06 |
| 1316113368 | Upper Cervical Clinics of Idaho | Clinic/Center | 3023 E Copper Point Dr Ste 104, Meridian, ID 83642-1740 | 2008-04-30 |
| 1801919204 | Meridian Pediatrics | Clinic/Center | 3653 N Locust Grove Rd, Meridian, ID 83646-5924 | 2007-04-09 |
| 1205996063 | Idaho Minor Emergency and Family Practice Pa | Clinic/Center | 3041 East Copper Pointe Drive, Meridian, ID 83642 | 2006-12-11 |
| 1710352356 | Anderson Regional Medical Center | Clinic/Center | 1523 22nd Ave Ste B, Meridian, MS 39301-4016 | 2015-12-08 |
| 1083852982 | Embrace Wellness | Clinic/Center | 1943 N Locust Grove Rd, Meridian, ID 83646 | 2009-01-30 |
| 1962622019 | Communicare, Inc | Clinic/Center | 40 W Franklin Rd, Suite F, Meridian, ID 83642-2965 | 2007-04-30 |
| Find all providers in MERIDIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.