Provider Demographics
NPI:1548282452
Name:PREMIER CLINICS PA
Entity type:Organization
Organization Name:PREMIER CLINICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EKUNSANMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-581-3000
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:120 YORK STREET
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-0159
Mailing Address - Country:US
Mailing Address - Phone:803-581-3000
Mailing Address - Fax:803-581-2997
Practice Address - Street 1:120 YORK ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1484
Practice Address - Country:US
Practice Address - Phone:803-581-3000
Practice Address - Fax:803-581-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19921261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3015Medicaid
SC6870Medicare PIN