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 State
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	207R00000X	Internal Medicine Physician	FL

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	:	1013086958
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	:	941 N 14TH ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-3838
Country	:	US
Telephone Number	:	352-326-4031
Fax Number	:	352-360-0257

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	05/10/2024

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