Provider Demographics
NPI:1154685014
Name:MISSION HEALTH INTEGRATIVE MEDICAL CLINIC
Entity Type:Organization
Organization Name:MISSION HEALTH INTEGRATIVE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BREZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-224-0127
Mailing Address - Street 1:7200 FRANCE AVE S
Mailing Address - Street 2:SUITE 233
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4300
Mailing Address - Country:US
Mailing Address - Phone:952-224-0127
Mailing Address - Fax:952-224-0128
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 233
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-224-0127
Practice Address - Fax:952-224-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center