Healthcare Provider Details

I. General information

NPI: 1255655429
Provider Name (Legal Business Name): PREMIER URGENT CARE AT KENNETT SQUARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD FORGE LANE STE 302
KENNETT SQUARE PA
19348
US

IV. Provider business mailing address

278 EAGLEVIEW BLVD
EXTON PA
19341-1157
US

V. Phone/Fax

Practice location:
  • Phone: 484-778-8000
  • Fax: 484-778-8001
Mailing address:
  • Phone: 610-561-6400
  • Fax: 610-561-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3939788
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3939788
License Number StatePA

VIII. Authorized Official

Name: EDWARD M SILVERMAN
Title or Position: CEO/PRESIDENT
Credential: D.O.
Phone: 610-247-0891