Healthcare Provider Details

I. General information

NPI: 1215150628
Provider Name (Legal Business Name): SENIOR CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 COLUMBINE DRIVE
WINSTON SALEM NC
27106-3112
US

IV. Provider business mailing address

147 COLUMBINE DRIVE
WINSTON SALEM NC
27106-3112
US

V. Phone/Fax

Practice location:
  • Phone: 336-777-1200
  • Fax: 336-777-0406
Mailing address:
  • Phone: 336-777-1200
  • Fax: 336-777-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number56910
License Number StateNC

VIII. Authorized Official

Name: DR. HERMAN ERNEST SCHMID JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 336-777-1200