# EPICENTERPHD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255862280
- **Authorized official:** MR. THOMAS WALTER MARTINI (CEO)
- **Authorized official phone:** (612) 203-2473

## Contact information

- **Practice address:** 8899 DEER VALLEY RD, PINE CITY, MN 55063-4424
- **Practice address phone:** (612) 203-2473
- **Practice address fax:** (612) 460-9804
- **Mailing address:** 8899 DEER VALLEY RD, PINE CITY, MN 55063-4424
- **Mailing address phone:** (612) 203-2473
- **Mailing address fax:** (612) 460-9804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225XH1300X | Human Factors Occupational Therapist | 380825 | MN | — |
| 253Z00000X | In Home Supportive Care Agency | 380825 | MN | Yes |
| 302R00000X | Health Maintenance Organization | 380825 | MN | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 380825 | MN | — |

## Other

- **Enumeration date:** 03/22/2017
- **Last updated:** 03/22/2017