Organization
S. KEITH HOLTON, PLLC
Active
Organization
S. KEITH HOLTON, PLLC
Active
Other names
MAGNOLIA OUTPATIENT REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOLTON (OFFICE MANAGER)
(662) 243-1097
Entity
Organization
Contact information
Practice address
2205 5TH ST N, COLUMBUS, MS 39705-2211
(662) 243-1097
(662) 243-1095
Mailing address
2205 5TH ST N, COLUMBUS, MS 39705-2211
(662) 243-1097
(662) 243-1095
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015582
—
MS
01
—
212664314B
BCBS OF MS PROV NUMBER
MS
Enumeration date
10/24/2006
Last updated
11/02/2011
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