Provider Demographics
NPI:1831599430
Name:MEDIFIT HEALTH, LLC
Entity type:Organization
Organization Name:MEDIFIT HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-352-8475
Mailing Address - Street 1:9201 QUADAY AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6604
Mailing Address - Country:US
Mailing Address - Phone:320-309-4781
Mailing Address - Fax:
Practice Address - Street 1:9201 QUADAY AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6604
Practice Address - Country:US
Practice Address - Phone:320-309-4781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REJUV MEDICAL, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty