Provider Demographics
NPI:1366774002
Name:MAGNACARE
Entity type:Organization
Organization Name:MAGNACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-919-7353
Mailing Address - Street 1:44 SIROCCO CT
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-1490
Mailing Address - Country:US
Mailing Address - Phone:304-919-7353
Mailing Address - Fax:
Practice Address - Street 1:44 SIROCCO CT
Practice Address - Street 2:
Practice Address - City:FALLING WATERS
Practice Address - State:WV
Practice Address - Zip Code:25419-1490
Practice Address - Country:US
Practice Address - Phone:304-919-7353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies