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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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103T00000XPsychologist
3207R00000XInternal Medicine Physician
4208600000XSurgery Physician
5291U00000XClinical Medical Laboratory06D2121590CO
6207RA0401XAddiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1043769862
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA MEDICAL COMPANY
Provider Business Mailing Address
First Line : 1850 RACE ST
Second Line :
City : DENVER
State : CO
Zip : 80206-1116
Country : US
Telephone Number :
Fax Number :
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 : 720-638-5562
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : PRADEEP RAJ RAI
Credential :
Telephone Number : 303-209-5115
Provider Enumeration Date : 09/22/2016
Last Update Date : 12/17/2024

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