Healthcare Provider Details

I. General information

NPI: 1083268189
Provider Name (Legal Business Name): MISSION CREEK TRANSITIONAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MARSHALL ST
DULUTH MN
55803-1981
US

IV. Provider business mailing address

5261 CARROLLTON PIKE STE C
WOODLAWN VA
24381-3034
US

V. Phone/Fax

Practice location:
  • Phone: 218-340-8674
  • Fax:
Mailing address:
  • Phone: 276-238-0911
  • Fax: 276-238-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN M FOX
Title or Position: OWNER
Credential: MD
Phone: 218-340-8674