MEDICARE: PRIME SCRUBS & MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1124562814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME SCRUBS & MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	8062 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-657-0457
Fax Number	:

Provider Business Practice Location Address
First Line	:	8062 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-657-0457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA MENSAH
Credential	:
Telephone Number	:	763-657-0457

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	08/27/2024

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