Healthcare Provider Details

I. General information

NPI: 1114549367
Provider Name (Legal Business Name): MAGNOLIA MEDICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 E COLFAX AVE
DENVER CO
80206-1604
US

IV. Provider business mailing address

PO BOX 29605 DEPT # 880927
PHOENIX AZ
85038-9605
US

V. Phone/Fax

Practice location:
  • Phone: 303-209-5115
  • Fax:
Mailing address:
  • Phone: 303-209-5115
  • Fax: 720-638-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VALERIE LAVOIE
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 303-945-1155