Organization
CENTERWELL SENIOR PRIMARY CARE (SC) PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE (SC) PC
Other names
Part in Primary Care SC PC, CenterWell Senior Primary Care-West Ashley, Partners in Primary Care NC PC, Partners In Primary Care- West Ashley
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE (SC) PC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
1401 SAM RITTENBERG BLVD STE 6, CHARLESTON, SC 29407-5031
(843) 973-5393
(833) 994-1098
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
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP9169
—
SC
01
—
L064
MEDICARE
SC
Enumeration date
07/17/2019
Last updated
08/19/2024
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