# CENTERWELL SENIOR PRIMARY CARE (LA) PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTERWELL SENIOR PRIMARY CARE (LA) PC
- **Other names:** CenterWell Senior Primary Care-Slidell
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285200048
- **Legal business name:** CENTERWELL SENIOR PRIMARY CARE (LA) PC
- **Authorized official:** ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
- **Authorized official phone:** (407) 447-7120

## Contact information

- **Practice address:** 1300 GAUSE BLVD STE C4, SLIDELL, LA 70458-3041
- **Practice address phone:** (985) 288-6419
- **Practice address fax:** (877) 889-8818
- **Mailing address:** 6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
- **Mailing address phone:** (305) 500-2000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 06/02/2021
- **Last updated:** 08/22/2024