Basic Information
| Provider Information | |||||||||
| NPI: | 1710395074 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER URGENT CARE AT KENNTT 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: | 2873 S EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102266200 | ||||||||
| FaxNumber: | 6102266201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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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 | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.