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General NPI Number Information
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NPI Number | 1548282452
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Entity Type | Organization
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Legal Business Name | PREMIER CLINICS PA
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 120 YORK ST
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City | CHESTER
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State | SC
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Zip | 29706-1484
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Country | US
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Telephone | 803-581-3000
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Fax | 803-581-2997
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Provider Business Mailing Address
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Address Line | PO BOX 159 120 YORK STREET
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City | CHESTER
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State | SC
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Zip | 29706-0159
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Country | US
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Telephone | 803-581-3000
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Fax | 803-581-2997
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. BAMIDELE A EKUNSANMI
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Credential | MD
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Telephone | 803-581-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 19921
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License Number State | SC
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