Provider Demographics
NPI:1811418445
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) 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: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:407-770-0661
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 208D00000X
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty