Organization
MAGNOLIA ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRICK ALVIN CORDER M.D. (OWNER/PHYSICIAN/MEDICAL DIRECTOR)
(662) 284-9902
Entity
Organization
Contact information
Practice address
3050 CORDER DR, CORINTH, MS 38834-6210
(662) 284-9902
(662) 284-9904
Mailing address
PO BOX 600, CORINTH, MS 38835-0600
(662) 284-9902
(662) 284-9904
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770615
—
MS
Enumeration date
11/29/2005
Last updated
09/08/2016
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