Healthcare Provider Details

I. General information

NPI: 1043091010
Provider Name (Legal Business Name): THRIVE MODERN HEALTH P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 YORK AVE S STE 157
EDINA MN
55435-4420
US

IV. Provider business mailing address

7101 YORK AVE S STE 157
EDINA MN
55435-4420
US

V. Phone/Fax

Practice location:
  • Phone: 612-254-6414
  • Fax:
Mailing address:
  • Phone: 612-386-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID BELSETH
Title or Position: DIRECTOR
Credential:
Phone: 612-730-2237