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General NPI Number Information
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NPI Number | 1114549367
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEDICAL COMPANY
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2925 E COLFAX AVE
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City | DENVER
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State | CO
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Zip | 80206-1604
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Country | US
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Telephone | 303-209-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 E COLFAX AVE
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City | DENVER
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State | CO
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Zip | 80206-1604
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Country | US
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Telephone | 303-209-5115
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Fax | 833-603-0135
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | VALERIE LAVOIE
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Credential |
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Telephone | 303-945-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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