| Magnolia Comprehensive Internal Medicine | |
|
564 Rio Lindo Ave Ste 102 Chico CA 95926-1852 | |
| (530) 965-9900 | |
| (530) 965-9265 |
| Full Name | Magnolia Comprehensive Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 564 Rio Lindo Ave Ste 102, Chico, California |
| Authorized Official Name and Position | Hilary Roberts (OFFICE MANAGER) |
| Authorized Official Contact | 5309659900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Comprehensive Internal Medicine 564 Rio Lindo Ave Ste 102 Chico CA 95926-1852 Ph: (530) 965-9900 | Magnolia Comprehensive Internal Medicine 564 Rio Lindo Ave Ste 102 Chico CA 95926-1852 Ph: (530) 965-9900 |
| NPI Number | 1235497611 |
|---|---|
| Provider Enumeration Date | 04/24/2012 |
| Last Update Date | 10/21/2024 |
| Medicare PECOS PAC ID | 3173756061 |
|---|---|
| Medicare Enrollment ID | O20140430000146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235497611 | NPI | - | NPPES |
| 1467403246 | Medicaid | CA | |
| 05D2283386 | Other | CA | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | A112504 (California) | Primary |
| Provider Name | David Alonso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467403246 PECOS PAC ID: 5193738672 Enrollment ID: I20101030000085 |
| Provider Name | Joy Ackles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063771277 PECOS PAC ID: 2668611062 Enrollment ID: I20130614000550 |
| Provider Name | Madison Wynne Dempewolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003434226 PECOS PAC ID: 2769875277 Enrollment ID: I20220204001769 |
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