| Premier Medical Center, Inc | |
|
5390 Dorchester Rd North Charleston SC 29418-5652 | |
| (843) 552-3099 | |
| (843) 552-3277 |
| Full Name | Premier Medical Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5390 Dorchester Rd, North Charleston, South Carolina |
| Authorized Official Name and Position | Eni Clement Okonofua (PRESIDENT) |
| Authorized Official Contact | 8435688330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical Center, Inc Po Box 31292 Charleston SC 29417-1292 Ph: (843) 552-3099 | Premier Medical Center, Inc 5390 Dorchester Rd North Charleston SC 29418-5652 Ph: (843) 552-3099 |
| NPI Number | 1699704569 |
|---|---|
| Provider Enumeration Date | 07/02/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 5294732772 |
|---|---|
| Medicare Enrollment ID | O20061025000524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699704569 | NPI | - | NPPES |
| T53518 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 21076 (South Carolina) | Primary |
| Provider Name | Eni Clement Okonofua |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295770436 PECOS PAC ID: 0941207427 Enrollment ID: I20061025000510 |
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