Provider Demographics
NPI:1689413882
Name:MAGNOLIA COLLECTIVE HEALTH, LLC
Entity type:Organization
Organization Name:MAGNOLIA COLLECTIVE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-884-0552
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-1637
Mailing Address - Country:US
Mailing Address - Phone:843-757-5400
Mailing Address - Fax:
Practice Address - Street 1:181 BLUFFTON RD STE G101-102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6221
Practice Address - Country:US
Practice Address - Phone:843-757-5400
Practice Address - Fax:843-757-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty