MEDICARE: SIMPLE SPECTRUM SERVICES LLC

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	:	1154115806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE SPECTRUM SERVICES LLC

Provider Business Mailing Address
First Line	:	4445 77TH ST W STE 106B
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 77TH ST W STE 106B
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5133
Country	:	US
Telephone Number	:	612-682-2569
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED KADAR
Credential	:
Telephone Number	:	612-682-2569

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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Directions to “SIMPLE SPECTRUM SERVICES LLC ” Practice Location

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