NPIMap

Organization Active NPI

Premier Clinics of York

  • Clinic/Center
  • York, SC
National Provider Identifier
1679589089
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 YORK
Doing business as
PREMIER CLINICS
Practice address
114 S Congress St
York, SC 29745-1837
Phone
(803) 628-4090
NPI assigned
Jul 31, 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.NPI 1932156171
Title
President/Medical Director
Phone
(803) 628-4090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

114 S Congress St
York, SC 29745-1837

Mailing address

PO Box 688
114 South Congress Street
York, SC 29745-0688
Phone (803) 628-4090

Other identifiers 1

IdentifierTypeStateIssuer
4459MedicaidSC

Other names 1

  • PREMIER CLINICS Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225756800000",
    "number": "1679589089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 688",
            "address_2": "114 SOUTH CONGRESS STREET",
            "city": "YORK",
            "state": "SC",
            "postal_code": "297450688",
            "telephone_number": "803-628-4090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 S CONGRESS ST",
            "city": "YORK",
            "state": "SC",
            "postal_code": "297451837",
            "telephone_number": "803-628-4090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CLINICS OF YORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "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": "803-628-4090",
        "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": "4459",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER CLINICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in York, 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.