| Mecca Medical Center, Llc | |
|
309 E College Dr Marshall MN 56258-2379 | |
| (507) 530-6028 | |
| Not Available |
| Full Name | Mecca Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 309 E College Dr, Marshall, Minnesota |
| Authorized Official Name and Position | Idriss Ibrahim (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5075306028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mecca Medical Center, Llc 1120 Birch St Apt 2 Marshall MN 56258-1550 Ph: () - | Mecca Medical Center, Llc 309 E College Dr Marshall MN 56258-2379 Ph: (507) 530-6028 |
| NPI Number | 1336790864 |
|---|---|
| Provider Enumeration Date | 09/25/2019 |
| Last Update Date | 02/20/2020 |
| Medicare PECOS PAC ID | 7911337886 |
|---|---|
| Medicare Enrollment ID | O20200416000469 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336790864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Idriss Ibrahim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336525666 PECOS PAC ID: 9537594288 Enrollment ID: I20200416000687 |
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