MAGNOLIA ENDOSCOPY CENTER LLC NPI 1740264274

NPI Information

  • NPI: 1740264274
  • Provider Name: MAGNOLIA ENDOSCOPY CENTER, LLC
  • Classification: Clinic/Center - 261QE0800X
  • Specialization: Endoscopy
  • Entity Type: Organization
  • CLIA Number: 25D1005167
  • Address: 3050 CORDER DR
    CORINTH, MS
    ZIP 38834
  • Phone: (662) 284-9902

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NPI Details

MAGNOLIA ENDOSCOPY CENTER, LLC is an endoscopy clinic center in Corinth, MS. MAGNOLIA ENDOSCOPY CENTER, LLC NPI is 1740264274. The provider is registered as an organization entity type.

The provider's business location address is:

3050 CORDER DR
CORINTH, MS
ZIP 38834-210
Phone: (662) 284-9902
Fax: (662) 284-9904

The provider's authorized official is Fredrick Alvin Corder .
The authorized official title is Owner/physician/medical Director and has the following contact phone number (662) 284-9902.

The CLIA number assigned to this NPI record is 25D1005167 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43239)
  • Dilation of esophagus (HCPCS:43450)
  • Removal of polyps or growths of large bowel using an endoscope with mechanical snare (HCPCS:45385)
  • Biopsy of large bowel using a flexible endoscope (HCPCS:45380)
  • Diagnostic exam of large bowel using a flexible endoscope (HCPCS:45378)
  • Colorectal cancer screening; colonoscopy on individual at high risk (HCPCS:G0105)
  • Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (HCPCS:G0121)
  • Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare (HCPCS:43251)
  • Injection beneath lining of large bowel using a flexible endoscope (HCPCS:45381)

The enumeration date for this NPI number is 11/29/2005 and was last updated on 9/8/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0800XClinic/CenterEndoscopyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100770615MEDICAIDMISSISSIPPI
2490000039MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPIFACILITY MEDICARE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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