Provider Demographics
NPI:1477271997
Name:MAGNOLIA MEDICAL COMPANY
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-209-5115
Mailing Address - Street 1:10515 E 40TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3264
Mailing Address - Country:US
Mailing Address - Phone:303-209-5115
Mailing Address - Fax:720-638-5562
Practice Address - Street 1:4990 KIPLING ST # B-5
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6762
Practice Address - Country:US
Practice Address - Phone:303-209-5115
Practice Address - Fax:720-638-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty