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General NPI Number Information
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NPI Number | 1891078606
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Entity Type | Organization
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Legal Business Name | PRIMARY CHOICE MEDICAL, PA
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 9 BUENA VISTA WAY
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City | GREENVILLE
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State | SC
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Zip | 29615-6621
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Country | US
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Telephone | 864-990-1825
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Fax | 864-284-0856
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Provider Business Mailing Address
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Address Line | 9 BUENA VISTA WAY
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City | GREENVILLE
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State | SC
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Zip | 29615-6621
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Country | US
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Telephone | 864-990-1825
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Fax | 864-284-0856
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD S PHILLIPS
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Credential | DO
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Telephone | 864-990-1825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0342
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License Number State | SC
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