MEDICARE: PATHCARE INC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1316589286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHCARE INC

Provider Business Mailing Address
First Line	:	333 WASHINGTON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2263
Country	:	US
Telephone Number	:	952-855-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2263
Country	:	US
Telephone Number	:	952-855-8563
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARYAN AHMED JAMA
Credential	:
Telephone Number	:	952-855-8563

Provider Enumeration Date	:	10/12/2019
Last Update Date	:	10/12/2019

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Directions to “PATHCARE INC ” Practice Location

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