Provider Demographics
NPI:1811417629
Name:CENTERWELL SENIOR PRIMARY CARE (NC) PC
Entity Type:Organization
Organization Name:CENTERWELL SENIOR PRIMARY CARE (NC) PC
Other - Org Name:PARTNERS IN PRIMARY CARE (NC), P.C.
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:
Authorized Official - Last Name:SAVAGE-JETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-256-6831
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 1:4700 MILLENIA BLVD STE 650
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6013
Practice Address - Country:US
Practice Address - Phone:407-447-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERWELL SENIOR PRIMARY CARE (NC) PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-22
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
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty