MEDICARE: SENIOR HEALTH CONNECTION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578597555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH CONNECTION

Provider Business Mailing Address
First Line	:	5000 AIRPORT CENTER PKWY STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5899
Country	:	US
Telephone Number	:	704-512-4116
Fax Number	:	704-371-7284

Provider Business Practice Location Address
First Line	:	7903 PROVIDENCE RD
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-9720
Country	:	US
Telephone Number	:	704-543-4360
Fax Number	:	704-544-2385

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	DANIEL L. WIENS
Credential	:
Telephone Number	:	704-355-0648

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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Directions to “SENIOR HEALTH CONNECTION ” Practice Location

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