Organization
MAGNOLIA PEDIATRIC CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY CROSS M.D. (OWNER/PRESIDENT)
(870) 234-5171
Entity
Organization
Contact information
Practice address
306 E MCNEIL, MAGNOLIA, AR 71753-2927
(870) 234-5171
(870) 234-0507
Mailing address
306 E MCNEIL, MAGNOLIA, AR 71753-2927
(870) 234-5171
(870) 234-0507
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E2147
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140579002
—
AR
Enumeration date
07/03/2006
Last updated
02/20/2012
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