Provider Demographics
NPI:1891931218
Name:EDINA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EDINA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-890-7546
Mailing Address - Street 1:7300 FRANCE AVE S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4525
Mailing Address - Country:US
Mailing Address - Phone:952-890-7546
Mailing Address - Fax:952-837-9001
Practice Address - Street 1:7300 FRANCE AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4525
Practice Address - Country:US
Practice Address - Phone:952-890-7546
Practice Address - Fax:952-837-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35804261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care