| Premier Clinics Of Rock Hill | |
|
1609 Constitution Blvd Rock Hill SC 29732-3047 | |
| (803) 326-3000 | |
| Not Available |
| Full Name | Premier Clinics Of Rock Hill |
|---|---|
| Speciality | Clinic/Center |
| Location | 1609 Constitution Blvd, Rock Hill, South Carolina |
| Authorized Official Name and Position | Bamidele A Ekunsanmi (PRESIDENT/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8033263000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Clinics Of Rock Hill Po Box 36291 Rock Hill SC 29732-0504 Ph: (803) 326-3000 | Premier Clinics Of Rock Hill 1609 Constitution Blvd Rock Hill SC 29732-3047 Ph: (803) 326-3000 |
| NPI Number | 1407860752 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 11/04/2008 |
| Medicare PECOS PAC ID | 3274604012 |
|---|---|
| Medicare Enrollment ID | O20080620000584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407860752 | NPI | - | NPPES |
| GP3014 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2019921 (South Carolina) | Primary |
| Provider Name | Bamidele A Ekunsanmi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932156171 PECOS PAC ID: 7012089311 Enrollment ID: I20080701000611 |
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