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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (TX) PA

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (TX) 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 : 1689491581
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE (TX) 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 : 407-447-7120
Fax Number : 407-770-0661
Provider Business Practice Location Address
First Line : 951 W BELT LINE RD STE 100
Second Line :
City : DESOTO
State : TX
Zip : 75115-3737
Country : US
Telephone Number : 972-734-8092
Fax Number : 214-306-8192
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 09/23/2024
Last Update Date : 12/17/2024

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Directions to “CENTERWELL SENIOR PRIMARY CARE (TX) PA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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