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 - Fairwold
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
5900 N MAIN ST, COLUMBIA, SC 29203-6227
(803) 610-4199
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
10/10/2024
Last updated
10/10/2024
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