# INTEGRATED CARE CLINICS, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great River Spine & Sport
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396775110
- **Authorized official:** BILL E MICKLE DC (OWNER)
- **Authorized official phone:** (763) 260-8401

## Contact information

- **Practice address:** 1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
- **Practice address phone:** (763) 260-8401
- **Practice address fax:** (763) 295-2208
- **Mailing address:** 1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
- **Mailing address phone:** (763) 263-8401
- **Mailing address fax:** (763) 263-5900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 44760 | MN | — |
| 2081P0004X | Spinal Cord Injury Medicine Physician | 44760 | MN | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 44760 | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 44760 | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | 44760 | MN | — |
| 225100000X | Physical Therapist | 8397 | MN | Yes |
| 363LF0000X | Family Nurse Practitioner | R182757-0 | MN | — |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 10/18/2019