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General NPI Number Information
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NPI Number | 1043091010
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Entity Type | Organization
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Legal Business Name | THRIVE MODERN HEALTH P.A.
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 7101 YORK AVE S STE 157
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City | EDINA
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State | MN
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Zip | 55435-4420
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Country | US
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Telephone | 612-254-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 YORK AVE S STE 157
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City | EDINA
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State | MN
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Zip | 55435-4420
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Country | US
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Telephone | 612-386-7939
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID BELSETH
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Credential |
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Telephone | 612-730-2237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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