# CENTERWELL SENIOR PRIMARY CARE (SC) JV PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTERWELL SENIOR PRIMARY CARE (SC) JV PC
- **Other names:** CenterWell Senior Primary Care-International Drive
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689481194
- **Legal business name:** CENTERWELL SENIOR PRIMARY CARE (SC) JV PC
- **Authorized official:** ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
- **Authorized official phone:** (407) 447-7120

## Contact information

- **Practice address:** 310 HINSON DR STE 3, MYRTLE BEACH, SC 29579-4435
- **Practice address phone:** (843) 966-0613
- **Practice address fax:** (843) 628-0979
- **Mailing address:** 6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
- **Mailing address phone:** (407) 447-7120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 12/17/2024
- **Last updated:** 01/06/2026