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General NPI Number Information
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NPI Number | 1144258849
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Entity Type | Organization
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Legal Business Name | EDINA FAMILY PHYSICIANS
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 5301 VERNON AVE S
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City | EDINA
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State | MN
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Zip | 55436-2303
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Country | US
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Telephone | 952-925-2200
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Fax | 952-925-0335
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Provider Business Mailing Address
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Address Line | 5301 VERNON AVE S
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City | EDINA
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State | MN
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Zip | 55436-2303
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Country | US
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Telephone | 952-925-2200
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Fax | 952-925-3450
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Authorized Official
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Title or Position | ADMININSTRATOR
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Name | MRS. LINDA MAE ODELL COWLES
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Credential | BSM, MA
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Telephone | 952-345-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 604
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License Number State | MN
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