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General NPI Number Information
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NPI Number | 1073702957
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Entity Type | Organization
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Legal Business Name | PRIMECARE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 145 ST JAMES AVE
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2923
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Country | US
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Telephone | 843-863-0777
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Fax | 843-824-6119
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | GOOSE CREEK
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State | SC
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Zip | 29445-0160
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Country | US
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Telephone | 843-863-0777
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Fax | 843-824-6119
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ADEBOLA EDWARD ROJUGBOKAN
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Credential | MD
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Telephone | 843-863-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21082
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License Number State | SC
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