MEDICARE: CENTERWELL SENIOR PRIMARY CARE SC JV PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1356040992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL SENIOR PRIMARY CARE SC JV PC

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2738 DECKER BLVD STE A
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1735
Country	:	US
Telephone Number	:	803-969-0543
Fax Number	:	877-958-9029

Authorized Official
Title or Position	:	SENIOR CREDENTIALING PROFESSIONAL
Name	:	ANGIE MARTINEZ
Credential	:
Telephone Number	:	407-447-7120

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	08/19/2024

Similar Medicare Providers

1467478735 — AMIT R PITALIA MD
Practice Location Address:

2738 DECKER BLVD STE A
COLUMBIA, SC
29206-1735

Practice Phone: 803-969-0543
Practice Fax: 877-958-9029

1679599237 — DR. UDAY DOPPALAPUDI M.D.
Practice Location Address:

2738 DECKER BLVD STE A
COLUMBIA, SC
29206-1735

Practice Phone: 803-969-0543
Practice Fax: 877-958-9029

1154321743 — JOHN C WALTHALL C.R.N.A.
Practice Location Address:

1735 TAYLOR ST
COLUMBIA, SC
29201-3452

Practice Phone: 803-254-8449
Practice Fax:

1881694982 — DR. RAY ANTHONY PHILLIPS DC
Practice Location Address:

330 N CHAUNCEY ST
COLUMBIA CITY, IN
46725-1735

Practice Phone: 260-244-6012
Practice Fax: 260-244-6012

1902891294 — DR. PHYLLIS MARIE BRYANT-MOBLEY M.D.
Practice Location Address:

1735 SAINT JULIAN PL STE 102
COLUMBIA, SC
29204-2402

Practice Phone: 803-497-9611
Practice Fax: 803-764-2003

1245288281 — AHP ASSOCIATES OF SOUTH CAROLINA LLC
Practice Location Address:

1735 TAYLOR ST
COLUMBIA, SC
29201-3452

Practice Phone: 803-254-8449
Practice Fax:

Directions to “CENTERWELL SENIOR PRIMARY CARE SC JV PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.