Basic Information
| Provider Information | |||||||||
| NPI: | 1255655429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER URGENT CARE AT KENNETT SQUARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 278 EAGLEVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193411157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105616400 | ||||||||
| FaxNumber: | 6105616401 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 OLD FORGE LANE | ||||||||
| Address2: | STE 302 | ||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847788000 | ||||||||
| FaxNumber: | 4847788001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2010 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | SILVERMAN | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6102470891 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3939788 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 3939788 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.