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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE KS PA

MEDICARE: CENTERWELL SENIOR PRIMARY CARE KS PA
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

General Provider Information

NPI Number : 1013438654
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE KS PA
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 : 16575 W 119TH ST
Second Line :
City : OLATHE
State : KS
Zip : 66061-7770
Country : US
Telephone Number : 913-815-5508
Fax Number : 855-446-7281
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 07/05/2017
Last Update Date : 08/19/2024

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1982991600 — DR. MICHELLE V. JONES PHARM.D.
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1053996371 — EMILY JOBSON PHARM.D.
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Directions to “CENTERWELL SENIOR PRIMARY CARE KS PA ” Practice Location

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