Healthcare Provider Details

I. General information

NPI: 1679084354
Provider Name (Legal Business Name): PREMIER URGENT CARE AT KENNETT SQUARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 BRYN MAWR AVENUE
PHILADELPHIA PA
19131-2399
US

IV. Provider business mailing address

278 EAGLEVIEW BLVD
EXTON PA
19341-1157
US

V. Phone/Fax

Practice location:
  • Phone: 215-883-0800
  • Fax: 215-364-6488
Mailing address:
  • Phone: 610-561-6400
  • Fax: 610-561-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD SILVERMAN
Title or Position: OWNER
Credential: DO
Phone: 610-561-6400