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Organization
CENTERWELL SENIOR PRIMARY CARE SC JV PC
Active
Organization
CENTERWELL SENIOR PRIMARY CARE SC JV PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE SC JV PC
Other names
CenterWell Senior Primary Care-Carolina Forest
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE SC JV PC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
3725 RENEE DR, MYRTLE BEACH, SC 29579-4109
(843) 350-1124
(877) 452-8854
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/02/2023
Last updated
08/19/2024
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