Provider Demographics
NPI:1255862280
Name:EPICENTERPHD INC
Entity Type:Organization
Organization Name:EPICENTERPHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-203-2473
Mailing Address - Street 1:8899 DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-4424
Mailing Address - Country:US
Mailing Address - Phone:612-203-2473
Mailing Address - Fax:612-460-9804
Practice Address - Street 1:8899 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-4424
Practice Address - Country:US
Practice Address - Phone:612-203-2473
Practice Address - Fax:612-460-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380825225XH1300X, 253Z00000X, 302R00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman FactorsGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies