Provider Demographics
NPI:1649926718
Name:PRIME TIME MEDICAL TRAINING, LLC
Entity type:Organization
Organization Name:PRIME TIME MEDICAL TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUVESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-563-9901
Mailing Address - Street 1:1342 81ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2116
Mailing Address - Country:US
Mailing Address - Phone:952-563-9901
Mailing Address - Fax:612-437-4733
Practice Address - Street 1:1342 81ST AVE NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2116
Practice Address - Country:US
Practice Address - Phone:952-563-9901
Practice Address - Fax:612-437-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory