MEDICARE: CENTERWELL SENIOR PRIMARY CARE NV CS 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	:	1255263356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL SENIOR PRIMARY CARE NV CS PC

Provider Business Mailing Address
First Line	:	2500 ANTHEM VILLAGE DR STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5562
Country	:	US
Telephone Number	:	702-843-1437
Fax Number	:	702-832-5775

Provider Business Practice Location Address
First Line	:	2500 ANTHEM VILLAGE DR STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5562
Country	:	US
Telephone Number	:	702-843-1437
Fax Number	:	702-832-5775

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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