| Organization Name: | MAGNOLIA SURGERY CENTER, LLC |
| NPI Number: | 1043565542 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVORY A KINSLOW (OWNER/MEDICAL DIRECTOR) |
| Mailing Address: | 25 Columbia Road 47 Magnolia |
| State: | AR US |
| Postal Code: | 71753 |
| Phone Number: | 8702345665 |
| Fax Number: | 8702345665 |
| NPI Enumeration Date: | 07/20/2012 |
| NPI Last Update Date: | 12/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |