| Premier Wellness Care | |
|
400 Pendleton Rd Clemson SC 29631-2211 | |
| (225) 620-6222 | |
| (864) 722-5319 |
| Full Name | Premier Wellness Care |
|---|---|
| Speciality | Family Medicine |
| Location | 400 Pendleton Rd, Clemson, South Carolina |
| Authorized Official Name and Position | Jacque Shadle (CEO) |
| Authorized Official Contact | 2254450038 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Wellness Care 400 Pendleton Rd Clemson SC 29631-2211 Ph: (864) 722-5315 | Premier Wellness Care 400 Pendleton Rd Clemson SC 29631-2211 Ph: (225) 620-6222 |
| NPI Number | 1528428299 |
|---|---|
| Provider Enumeration Date | 02/24/2016 |
| Last Update Date | 06/01/2016 |
| Medicare PECOS PAC ID | 3577853969 |
|---|---|
| Medicare Enrollment ID | O20160525002871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528428299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian K Mccormick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861584419 PECOS PAC ID: 5890775779 Enrollment ID: I20040721001407 |
| Provider Name | Jason E Gosnell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750519278 PECOS PAC ID: 9234384314 Enrollment ID: I20130220000378 |
| Provider Name | Benjamin David Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871047787 PECOS PAC ID: 8224324736 Enrollment ID: I20160909001032 |
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