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NPI Code Detail

MEDICARE: MAGNOLIA MEDICAL COMPANY

MEDICARE: MAGNOLIA MEDICAL COMPANY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2208600000XSurgery Physician
3101YA0400XAddiction (Substance Use Disorder) Counselor
4291U00000XClinical Medical Laboratory
5103T00000XPsychologist
6207RA0401XAddiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1114549367
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA MEDICAL COMPANY
Provider Business Mailing Address
First Line : PO BOX 29605
Second Line : DEPT # 880927
City : PHOENIX
State : AZ
Zip : 85038-9605
Country : US
Telephone Number : 303-209-5115
Fax Number : 720-638-5562
Provider Business Practice Location Address
First Line : 2925 E COLFAX AVE
Second Line :
City : DENVER
State : CO
Zip : 80206-1604
Country : US
Telephone Number : 303-209-5115
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATION
Name : VALERIE LAVOIE
Credential :
Telephone Number : 303-945-1155
Provider Enumeration Date : 05/11/2020
Last Update Date : 02/17/2026

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Directions to “MAGNOLIA MEDICAL COMPANY ” Practice Location

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