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General NPI Number Information
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NPI Number | 1699704569
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL CENTER, INC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5390 DORCHESTER RD
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-5652
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Country | US
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Telephone | 843-552-3099
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Fax | 843-552-3277
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Provider Business Mailing Address
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Address Line | PO BOX 31292
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City | CHARLESTON
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State | SC
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Zip | 29417-1292
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Country | US
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Telephone | 843-552-3099
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Fax | 843-559-9037
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENI CLEMENT OKONOFUA
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Credential | M.B.,B.S
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Telephone | 843-568-8330
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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 | 21076
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License Number State | SC
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