MEDICARE: PRIME HEALING 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1831913847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALING INC

Provider Business Mailing Address
First Line	:	2704 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1127
Country	:	US
Telephone Number	:	612-426-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	2704 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1127
Country	:	US
Telephone Number	:	612-426-9982
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AYUB AHMED ALI
Credential	:
Telephone Number	:	612-426-9982

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	11/15/2024

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