Provider Demographics
NPI:1639692098
Name:CENTERWELL SENIOR PRIMARY CARE (MO) PC
Entity Type:Organization
Organization Name:CENTERWELL SENIOR PRIMARY CARE (MO) PC
Other - Org Name:PARTNERS IN PRIMARY CARE MO 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:LACHE'
Authorized Official - Last Name:SAVAGE-JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-216-4620
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:407-770-0661
Practice Address - Street 1:301 E ARMOUR BLVD STE 2EAST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1245
Practice Address - Country:US
Practice Address - Phone:816-394-2082
Practice Address - Fax:855-446-7255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERWELL SENIOR PRIMARY CARE (MO) PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-18
Last Update Date:2022-10-20
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