NPIMap

Organization Active NPI

Premier Clinics of Rock Hill

  • Clinic/Center
  • Rock Hill, SC
National Provider Identifier
1407860752
Registry record updated Nov 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2019921 Issued in SC
Legal business name
PREMIER CLINICS OF ROCK HILL
Practice address
1609 Constitution Blvd
Rock Hill, SC 29732-3047
Phone
(803) 326-3000
NPI assigned
Jul 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bamidele A Ekunsanmi, M.D
Title
President/Medical Director
Phone
(803) 326-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2019921 SC Primary

Addresses

Primary practice location

1609 Constitution Blvd
Rock Hill, SC 29732-3047

Mailing address

PO Box 36291
Rock Hill, SC 29732-0504
Phone (803) 326-3000

Other identifiers 1

IdentifierTypeStateIssuer
GP3014MedicaidSC

Other names 1

  • PREMIER CLINICS Doing business as

National Provider Directory

National Provider Directory

Locations

120 York St
Chester, SC 29706
Phone (803) 581-3000

1609 Constitution Blvd
Rock Hill, SC 29732
Phone (803) 326-3000

225 Herlong Ave S
Ste 250
Rock Hill, SC 29732
Phone (803) 325-8742

114 Congress St S
York, SC 29745
Phone (803) 307-4647

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225756800000",
    "number": "1407860752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36291",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297320504",
            "telephone_number": "803-326-3000",
            "fax_number": "803-326-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 CONSTITUTION BLVD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323047",
            "telephone_number": "803-326-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CLINICS OF ROCK HILL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-11-04",
        "status": "A",
        "authorized_official_last_name": "EKUNSANMI",
        "authorized_official_first_name": "BAMIDELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "803-326-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "2019921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3014",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER CLINICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.