Organization
PREMIER URGENT CARE AT KENNETT SQUARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA O'GORMAN (CREDENTIALING MANAGER)
(215) 552-2818
Entity
Organization
Contact information
Practice address
10050 ROOSEVELT BLVD STE 2, PHILADELPHIA, PA 19116-3965
(215) 552-2818
(484) 713-5255
Mailing address
10050 ROOSEVELT BLVD STE 2, PHILADELPHIA, PA 19116-3965
(215) 552-2818
(484) 713-5255
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027657760001
—
PA
Enumeration date
01/23/2018
Last updated
06/16/2018
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