Provider Demographics
NPI:1114137213
Name:PRIME MERIDIAN, INC.
Entity Type:Organization
Organization Name:PRIME MERIDIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:TIMOTHY DAVID
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-870-1500
Mailing Address - Street 1:501 MARQUETTE AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-1201
Mailing Address - Country:US
Mailing Address - Phone:612-870-1500
Mailing Address - Fax:612-870-1551
Practice Address - Street 1:501 MARQUETTE AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1201
Practice Address - Country:US
Practice Address - Phone:612-870-1500
Practice Address - Fax:612-870-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty