Provider Demographics
NPI:1053774422
Name:MAGNOLIA NETWORKS LLC
Entity type:Organization
Organization Name:MAGNOLIA NETWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:412-914-8484
Mailing Address - Street 1:316 STATION ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1833
Mailing Address - Country:US
Mailing Address - Phone:412-914-8484
Mailing Address - Fax:412-914-8179
Practice Address - Street 1:316 STATION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1833
Practice Address - Country:US
Practice Address - Phone:412-914-8484
Practice Address - Fax:412-914-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty