Provider Demographics
NPI:1699047514
Name:PALLADIUM PRIMARY CARE INC
Entity type:Organization
Organization Name:PALLADIUM PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
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:PO BOX 38774
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-8774
Mailing Address - Country:US
Mailing Address - Phone:336-841-8500
Mailing Address - Fax:336-841-3999
Practice Address - Street 1:2510 HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-3142
Practice Address - Country:US
Practice Address - Phone:336-676-6700
Practice Address - Fax:336-841-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty