Healthcare Provider Details

I. General information

NPI: 1154247807
Provider Name (Legal Business Name): LATIMER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 ANTHONY LN
ST ANTHONY VILLAGE MN
55418-3250
US

IV. Provider business mailing address

2924 ANTHONY LN
ST ANTHONY VILLAGE MN
55418-3250
US

V. Phone/Fax

Practice location:
  • Phone: 651-397-0313
  • Fax: 651-397-0041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KHADIR TABABOUANGA ALBERT
Title or Position: OWNER, CEO
Credential:
Phone: 952-210-4481