Organization
EPICENTERPHD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS WALTER MARTINI (CEO)
(612) 203-2473
Entity
Organization
Contact information
Practice address
8899 DEER VALLEY RD, PINE CITY, MN 55063-4424
(612) 203-2473
(612) 460-9804
Mailing address
8899 DEER VALLEY RD, PINE CITY, MN 55063-4424
(612) 203-2473
(612) 460-9804
Taxonomy
Speciality
Code
Description
License number
State
225XH1300X
Human Factors Occupational Therapist
380825
MN
253Z00000X
In Home Supportive Care Agency
Primary
380825
MN
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
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