# MAGNOLIA MED SPA AND IV THERAPY INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAGNOLIA MED SPA AND IV THERAPY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699513598
- **Authorized official:** BRITTANY LEE BALLARD BSN (OWNER)
- **Authorized official phone:** (580) 615-0000

## Contact information

- **Practice address:** 3008 W UNIVERSITY BLVD STE 130, DURANT, OK 74701-2927
- **Practice address phone:** (580) 615-0000
- **Practice address fax:** (580) 615-0001
- **Mailing address:** 3008 W UNIVERSITY BLVD STE 130, DURANT, OK 74701-2927
- **Mailing address phone:** (580) 615-0000
- **Mailing address fax:** (580) 615-0001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2024
- **Last updated:** 07/16/2024