Provider Demographics
NPI:1477342905
Name:BRISTOL PRIME CARE LLC
Entity type:Organization
Organization Name:BRISTOL PRIME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NUH
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-228-4504
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2915
Mailing Address - Country:US
Mailing Address - Phone:952-228-4504
Mailing Address - Fax:952-228-4504
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 113
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2915
Practice Address - Country:US
Practice Address - Phone:952-228-4504
Practice Address - Fax:952-228-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center