| Prime Minded Care | |
|
46-48 Crawford St Apt 3 Newark NJ 07102-1157 | |
| (216) 235-5484 | |
| Not Available |
| Full Name | Prime Minded Care |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 46-48 Crawford St Apt 3, Newark, New Jersey |
| Authorized Official Name and Position | Alimata Sore Ouedraogo (OWNER) |
| Authorized Official Contact | 2162355484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Minded Care 46-48 Crawford St Apt 3 Newark NJ 07102-1157 Ph: (216) 235-5484 | Prime Minded Care 46-48 Crawford St Apt 3 Newark NJ 07102-1157 Ph: (216) 235-5484 |
| NPI Number | 1841937893 |
|---|---|
| Provider Enumeration Date | 05/19/2022 |
| Last Update Date | 05/19/2022 |
| Certification Date | 05/19/2022 |
| Medicare PECOS PAC ID | 3375922453 |
|---|---|
| Medicare Enrollment ID | O20220621000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841937893 | NPI | - | NPPES |
| S65780240061822 | Other | NJ | DRIVING LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Alimata Sore Ouedraogo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639778301 PECOS PAC ID: 9032521315 Enrollment ID: I20201210000346 |
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