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General NPI Number Information
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NPI Number | 1508102500
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Entity Type | Organization
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Legal Business Name | REALIEF MEDICAL P.A.
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1660 HIGHWAY 100 S SUITE 229
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1529
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Country | US
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Telephone | 952-456-6160
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Fax | 952-456-6184
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Provider Business Mailing Address
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Address Line | 1660 HIGHWAY 100 S SUITE 229
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1529
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Country | US
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Telephone | 952-456-6160
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Fax | 952-456-6184
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JESSICA HALEY
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Credential |
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Telephone | 952-456-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 24538
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License Number State | MN
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