MAGNOLIA GROVE HEALTHCARE - NPI 1710179395 - Clinic/Center in Gulfport, MS

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.

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About Magnolia Grove Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA GROVE HEALTHCARE (NPI 1710179395) is a healthcare organization registered as a primary care in Gulfport, Mississippi and active in the NPI registry since August 2007. The organization lists Tracey Decena, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1710179395

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameMAGNOLIA GROVE HEALTHCARE

Location Address4333 15TH ST STE AGulfport, MS 39501-2525

Mailing AddressPo Box 1040Gulfport, MS 39502-1040 · (228) 863-4000 · Fax (228) 863-4003

Phone(228) 863-4000

Fax(228) 863-4003

Organization SubpartNo

Authorized OfficialTracey DecenaOffice Manager · (228) 863-4000

Enumeration DateAugust 16, 2007

✔ NPI 1710179395 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

License✔ Licensed in MS · 12792

4333 15TH ST STE A, Gulfport, MS 39501

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. HOLLY WILLIAMS CUEVAS NP-C

Nurse Practitioner (Family)

4333 15TH ST STE A
GULFPORT, MS 39501

Harrison County (228) 863-4000

Frequently Asked Questions

What is MAGNOLIA GROVE HEALTHCARE's NPI number?

The NPI number assigned to this healthcare provider is 1710179395, enumerated as an "organization" on August 16, 2007.

Where is the provider located?

The provider is located at 4333 15TH ST STE A GULFPORT, MS 39501 and the phone number is (228) 863-4000.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.