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PRIMARY ENT L.L.C. NPI 1386374593


NPI Information

NPI: 1386374593
Provider Name: PRIMARY ENT, L.L.C.

Doing Business As: PRIMARY ENT

Classification: Otolaryngology - 207YX0905X
Entity Type: Organization

Specialization: Otolaryngology/Facial Plastic Surgery

CLIA Number: 24D2280302

Address:
14020 HWY 13 S STE 350
SAVAGE, MN
ZIP 55378
Phone: (952) 395-2500
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PRIMARY ENT, L.L.C. is an otolaryngology/facial plastic surgery otolaryngology in Savage, MN. The provider is an otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. PRIMARY ENT, L.L.C. NPI is 1386374593. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Primary Ent.

The provider's business location address is:

14020 HWY 13 S STE 350
SAVAGE, MN
ZIP 55378-103
Phone: (952) 395-2500
Fax: (952) 395-2501

The provider's authorized official is John Luther Boone .
The authorized official title is Owner/president and has the following contact phone number (612) 406-9966.

The CLIA number assigned to this NPI record is 24D2280302 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/13/2022 and was last updated on 11/17/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Y00000XOtolaryngologyNo
2207YX0905XOtolaryngologyOtolaryngology/Facial Plastic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11609035781MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.