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General NPI Number Information
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NPI Number | 1891931218
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Entity Type | Organization
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Legal Business Name | EDINA MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 7300 FRANCE AVE S SUITE 300
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City | EDINA
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State | MN
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Zip | 55435-4525
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Country | US
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Telephone | 952-890-7546
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Fax | 952-837-9001
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Provider Business Mailing Address
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Address Line | 7300 FRANCE AVE S SUITE 300
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City | EDINA
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State | MN
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Zip | 55435-4525
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Country | US
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Telephone | 952-890-7546
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Fax | 952-837-9001
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARK ANDREW RAWSON
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Credential | M.D.
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Telephone | 952-890-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35804
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License Number State | MN
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