Spectrum Development Center Service Corporation

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SPECTRUM DEVELOPMENT CENTER SERVICE CORPORATION

Practice address

14540 Pennock Ave Ste 102
Apple Valley, MN 55124-7443

Phone

(612) 366-4807

NPI assigned

Dec 12, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ahmedkhadar Warsame

Title

Owner

Phone

(612) 366-4807

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1134936230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14540 PENNOCK AVE STE 102",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 PENNOCK AVE STE 102",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247443",
            "telephone_number": "612-366-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM DEVELOPMENT CENTER SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-12",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "WARSAME",
        "authorized_official_first_name": "AHMEDKHADAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-366-4807"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.