| Primemed PLLC | |
|
322 W Lake St Ste 101 Minneapolis MN 55408-3025 | |
| (857) 492-6395 | |
| (612) 465-4470 |
| Full Name | Primemed PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 322 W Lake St Ste 101, Minneapolis, Minnesota |
| Authorized Official Name and Position | Mohamed Adan (PHYSICIAN ASSISTANT) |
| Authorized Official Contact | 8574926395 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primemed PLLC 322 W Lake St Ste 101 Minneapolis MN 55408-3025 Ph: (857) 492-6395 | Primemed PLLC 322 W Lake St Ste 101 Minneapolis MN 55408-3025 Ph: (857) 492-6395 |
| NPI Number | 1396450953 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Medicare PECOS PAC ID | 6709241185 |
|---|---|
| Medicare Enrollment ID | O20230509000965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396450953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Abass a Basha |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689080566 PECOS PAC ID: 8022237031 Enrollment ID: I20140923002210 |
| Provider Name | Mohamed Adan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336725837 PECOS PAC ID: 0547646531 Enrollment ID: I20230509000904 |
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