Organization
MAGNOLIA MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA BEESLEY (BILLING MANAGER)
(601) 442-6493
Entity
Organization
Contact information
Practice address
626 VEROT SCHOOL RD STE C, LAFAYETTE, LA 70508-5094
(337) 210-2060
(888) 544-6008
Mailing address
5412 DIJON DR, BATON ROUGE, LA 70808-4315
(225) 615-8693
(888) 544-6008
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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