| Magnolia Critical Care And Internal Medicine | |
|
2475 Broadway Bluffs Drive Ste. 301 Columbia MO 65201-8128 | |
| (573) 874-3235 | |
| (573) 817-5917 |
| Full Name | Magnolia Critical Care And Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 2475 Broadway Bluffs Drive, Columbia, Missouri |
| Authorized Official Name and Position | Rachna Puri (OFFICE MANAGER) |
| Authorized Official Contact | 5738743235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Critical Care And Internal Medicine 2475 Broadway Bluffs Drive Ste. 301 Columbia MO 65201-8128 Ph: (573) 874-3235 | Magnolia Critical Care And Internal Medicine 2475 Broadway Bluffs Drive Ste. 301 Columbia MO 65201-8128 Ph: (573) 874-3235 |
| NPI Number | 1306937974 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 11/19/2012 |
| Medicare PECOS PAC ID | 8820054497 |
|---|---|
| Medicare Enrollment ID | O20041206000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306937974 | NPI | - | NPPES |
| 509179305 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RC0200X | Internal Medicine - Critical Care Medicine | (* (Not Available)) | Secondary |
| Provider Name | Raman Puri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295756906 PECOS PAC ID: 8527115724 Enrollment ID: I20100827000933 |
| Provider Name | Cathy A Hartle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669598710 PECOS PAC ID: 2769700434 Enrollment ID: I20150408001730 |
| Provider Name | Travis Michael Birkhead |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1477016301 PECOS PAC ID: 7012249162 Enrollment ID: I20220615002972 |
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