Provider Demographics
NPI:1376574004
Name:PREMIERE HEALTH CARE PLUS PA
Entity Type:Organization
Organization Name:PREMIERE HEALTH CARE PLUS PA
Other - Org Name:DBA PALLADIUM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI-BONSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-841-8500
Mailing Address - Street 1:3750 ADMIRAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGHPOINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1556
Mailing Address - Country:US
Mailing Address - Phone:336-841-8500
Mailing Address - Fax:336-841-3999
Practice Address - Street 1:3750 ADMIRAL DR STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1556
Practice Address - Country:US
Practice Address - Phone:336-841-8500
Practice Address - Fax:336-841-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIERE HEALTH CARE PLUS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950538Medicaid