Provider Demographics
NPI:1619318896
Name:PRIORITY HEALTH
Entity Type:Organization
Organization Name:PRIORITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YUSEF
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SALEEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-656-2297
Mailing Address - Street 1:P.O. BOX 4177
Mailing Address - Street 2:PRIORITY HEALTH, LLC
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:800-965-8482
Mailing Address - Fax:888-242-0735
Practice Address - Street 1:675 WACHESAW ROAD
Practice Address - Street 2:UNIT D
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:800-965-8482
Practice Address - Fax:888-242-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC21299208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF61643Medicare UPIN
GA93BBJPPMedicare PIN