Healthcare Provider Details

I. General information

NPI: 1497599724
Provider Name (Legal Business Name): MRS ACQUISITION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8053 E BLOOMINGTON FWY
BLOOMINGTON MN
55420-4577
US

IV. Provider business mailing address

8053 E BLOOMINGTON FWY
BLOOMINGTON MN
55420-4577
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-2155
  • Fax: 612-333-5517
Mailing address:
  • Phone: 612-333-2155
  • Fax: 612-333-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN KING
Title or Position: OWNER
Credential:
Phone: 612-333-2155