Healthcare Provider Details

I. General information

NPI: 1427708692
Provider Name (Legal Business Name): PRIMECARE MIDWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 PARK CENTER BLVD APT 605
MINNEAPOLIS MN
55416-2562
US

IV. Provider business mailing address

3601 PARK CENTER BLVD APT 605
MINNEAPOLIS MN
55416-2562
US

V. Phone/Fax

Practice location:
  • Phone: 612-876-6648
  • Fax:
Mailing address:
  • Phone: 612-876-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABDINAJIB IBRAHIM HUSSEIN
Title or Position: OWNER/GM
Credential:
Phone: 612-876-6648