| Primecare Family Practice Llc | |
|
145 St James Ave Goose Creek SC 29445-2923 | |
| (843) 863-0777 | |
| (843) 824-6119 |
| Full Name | Primecare Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 145 St James Ave, Goose Creek, South Carolina |
| Authorized Official Name and Position | Adebola Edward Rojugbokan (PHYSICIAN) |
| Authorized Official Contact | 8438630777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Family Practice Llc Po Box 160 Goose Creek SC 29445-0160 Ph: (843) 863-0777 | Primecare Family Practice Llc 145 St James Ave Goose Creek SC 29445-2923 Ph: (843) 863-0777 |
| NPI Number | 1073702957 |
|---|---|
| Provider Enumeration Date | 10/17/2007 |
| Last Update Date | 04/14/2008 |
| Medicare PECOS PAC ID | 1850364431 |
|---|---|
| Medicare Enrollment ID | O20040813000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073702957 | NPI | - | NPPES |
| GP3958 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 21082 (South Carolina) | Primary |
| Provider Name | Adebola E Rojugbokan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922015692 PECOS PAC ID: 9931172517 Enrollment ID: I20040817000077 |
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