MEDICARE: PRIORITY HEALTH CENTER

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1912606930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	3055 OLD HIGHWAY 8 STE 211
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2492
Country	:	US
Telephone Number	:	612-261-8640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 OLD HIGHWAY 8 STE 211
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2492
Country	:	US
Telephone Number	:	612-261-8640
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ABDIWAHID ADAM
Credential	:
Telephone Number	:	612-261-8640

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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