# CENTERWELL SENIOR PRIMARY CARE (SC) PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTERWELL SENIOR PRIMARY CARE (SC) PC
- **Other names:** CenterWell Senior Primary Care - Powdersville, Parterns in Primary Care- Powdersville, Partners in Primary Care NC PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1841644580
- **Legal business name:** CENTERWELL SENIOR PRIMARY CARE (SC) PC
- **Authorized official:** ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
- **Authorized official phone:** (407) 447-7120

## Contact information

- **Practice address:** 3516 HIGHWAY 153, GREENVILLE, SC 29611-7553
- **Practice address phone:** (864) 729-6626
- **Practice address fax:** (855) 617-4425
- **Mailing address:** 6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
- **Mailing address phone:** (305) 500-2000

## 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:** 04/19/2016
- **Last updated:** 08/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP7379 | — | SC |
| 01 | — | L064 | MEDICARE | SC |