Provider Demographics
NPI:1093179426
Name:CENTERWELL SENIOR PRIMARY CARE (SC) PC
Entity Type:Organization
Organization Name:CENTERWELL SENIOR PRIMARY CARE (SC) PC
Other - Org Name:PARTNERS IN PRIMARY CARE NC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAVAGE-JETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-447-7120
Mailing Address - Street 1:4700 MILLENIA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:
Practice Address - Street 1:805 W WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1311
Practice Address - Country:US
Practice Address - Phone:864-655-6615
Practice Address - Fax:855-617-4423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERWELL SENIOR PRIMARY CARE (SC) PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty