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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (FL) INC.

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (FL) INC.
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
1207Q00000XFamily Medicine Physician
2208D00000XGeneral Practice Physician
3207R00000XInternal Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number : 1558912659
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE (FL) INC.
Provider Business Mailing Address
First Line : 4700 MILLENIA BLVD STE 650
Second Line :
City : ORLANDO
State : FL
Zip : 32839-6013
Country : US
Telephone Number : 407-447-7120
Fax Number :
Provider Business Practice Location Address
First Line : 737 S SEMORAN BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32807-3121
Country : US
Telephone Number : 321-247-4960
Fax Number : 833-963-0116
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 09/20/2019
Last Update Date : 05/10/2024

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Directions to “CENTERWELL SENIOR PRIMARY CARE (FL) INC. ” Practice Location

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