Provider Demographics
NPI:1821168055
Name:SENIOR CARE SYSTEMS, P.A.
Entity Type:Organization
Organization Name:SENIOR CARE SYSTEMS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTTON-SURAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-686-1099
Mailing Address - Street 1:1013 PORTERS NECK RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8130
Mailing Address - Country:US
Mailing Address - Phone:910-686-1099
Mailing Address - Fax:910-686-4715
Practice Address - Street 1:1013 PORTERS NECK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-686-1099
Practice Address - Fax:910-686-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890164HMedicaid
NC2344561Medicare ID - Type Unspecified