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

Active since August 16, 2007
4333 15TH ST STE A, GULFPORT, MS 39501(228) 863-4000(228) 863-4003 Get Directions Write a Review

NPPES record last updated: August 16, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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 NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Grove Healthcare's NPI number?

The NPI number for Magnolia Grove Healthcare is 1710179395. It was assigned to this organization in the NPPES registry on August 16, 2007.

Where is Magnolia Grove Healthcare located?

Magnolia Grove Healthcare is located at 4333 15th St Ste A, Gulfport, MS 39501. The listed phone number is (228) 863-4000.

What is Magnolia Grove Healthcare's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Magnolia Grove Healthcare was last updated on August 16, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.