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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 (SC) JV PC - Forest
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE (SC) JV PC
Authorized official
MEGAN GALVAN (CREDENTIALING MANAGER)
(305) 500-2000
Entity
Organization
Contact information
Practice address
2571 FOREST DR, COLUMBIA, SC 29204-2029
(803) 888-5425
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
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
10/10/2024
Last updated
10/10/2024
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