Provider Demographics
NPI:1497517130
Name:EDEN MEDICAL GROUP
Entity type:Organization
Organization Name:EDEN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMO
Authorized Official - Middle Name:OSMAN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:612-481-0603
Mailing Address - Street 1:2226 119TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5440
Mailing Address - Country:US
Mailing Address - Phone:612-481-0603
Mailing Address - Fax:
Practice Address - Street 1:2226 119TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5440
Practice Address - Country:US
Practice Address - Phone:612-481-0603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care