MAGNOLIA FAMILY CARE (NPI# 1356904353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356904353 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA FAMILY CARE |
| Practice Address |
777 W Duval St Lake City FL 32055-5806 |
| Practice Telephone | 3867553300 |
| Mailing Telephone | 3867553300 |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2019-04-16 |
| Authorized Official Name | MR. BILAL M KHODR (OWNER) |
| Authorized Official Telephone | 3867553300 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS | 41469 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MAGNOLIA FAMILY CARE CORP | 777 W Duval St, Lake City, FL 32055-5806 |
| Street Address |
777 W DUVAL ST |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-5806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689654584 | Ira Lee | Nurse Practitioner | 777 W Duval St, Lake City, FL 32055-5806 | 2006-01-18 |
| 1316581879 | Jennifer Lyn Bryan | Registered Nurse | 777 W Duval St, Lake City, FL 32055-5806 | 2019-10-28 |
| 1013457134 | Heather Langston Finnell | Nurse Practitioner | 777 W Duval St, Lake City, FL 32055-5806 | 2017-03-08 |
| 1477785095 | Enrique Technologies Inc | Clinic/Center | 777 W Duval St, Lake City, FL 32055-5806 | 2009-08-14 |
| 1477631752 | Hc Healthcare Inc | Clinic/Center | 777 W Duval St, Lake City, FL 32055-5806 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538655766 | Silver Thread Public Health District | Family Medicine | 304 W. 3rd St, Lake City, CO 81235-0277 | 2018-07-11 |
| 1467814582 | Osayamen O Omoruyi | Family Medicine | 4784 W Us Highway 90, Lake City, FL 32055-3101 | 2016-03-28 |
| 1255698619 | Osayande Stephen Izeiyamu | Family Medicine | 194 Sw Wall Ter, Lake City, FL 32025-5086 | 2012-04-23 |
| 1811206923 | Riverside Medical Clinic | Family Medicine | 803 Hwy 18, Lake City, AR 72347-0505 | 2010-10-07 |
| 1508181272 | Dynamic Health Centers | Family Medicine | 163 Sw Stonegate Ter Ste 109, Lake City, FL 32024-3459 | 2010-04-06 |
| 1659506699 | Live Oak Medical Center, Pa | Family Medicine | 148 Sauls St., Lake City, SC 29560 | 2009-05-20 |
| 1871776732 | Javier D Amador | Family Medicine | 484 Sw Commerce Dr Ste 140, Lake City, FL 32025-1588 | 2007-12-13 |
| 1699838003 | Peter Wendell Giebeig Jr. | Family Medicine | 5085 West Us Hwy 90, Lake City, FL 32055 | 2006-12-18 |
| 1568544054 | Miguel Jose Tepedino | Family Medicine | 1717 Sw Newland Way, Lake City, FL 32025-6966 | 2006-10-20 |
| 1801992599 | Morris E Brown IIi | Family Medicine | 901 N. Matthews Road, Lake City, SC 29560-7024 | 2006-09-16 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.