Provider Demographics
NPI:1952094476
Name:MAGNOLIA MEDICAL COMPANY
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-909-3890
Mailing Address - Street 1:2925 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1604
Mailing Address - Country:US
Mailing Address - Phone:303-209-5115
Mailing Address - Fax:833-603-0135
Practice Address - Street 1:9572 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE HILLS
Practice Address - State:OH
Practice Address - Zip Code:43065-8973
Practice Address - Country:US
Practice Address - Phone:303-209-5115
Practice Address - Fax:833-603-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty