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Organization

PREMIER CLINICS OF YORK

Active
Other names
PREMIER CLINICS
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BAMIDELE A EKUNSANMI M.D. (PRESIDENT/MEDICAL DIRECTOR)
(803) 628-4090
Entity
Organization

Contact information

Practice address
114 S CONGRESS ST, YORK, SC 29745-1837
(803) 628-4090
Mailing address
PO BOX 688, 114 SOUTH CONGRESS STREET, YORK, SC 29745-0688
(803) 628-4090

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2019921
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4459
SC
Enumeration date
07/31/2006
Last updated
11/04/2008
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