# CENTERWELL SENIOR PRIMARY CARE (LA) PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CenterWell Senior Primary Care-Covington
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326620626
- **Authorized official:** ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
- **Authorized official phone:** (407) 447-7120

## Contact information

- **Practice address:** 66 PARK PLACE DR, COVINGTON, LA 70433-5183
- **Practice address phone:** (985) 875-5459
- **Practice address fax:** (877) 872-3840
- **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:** 04/26/2021
- **Last updated:** 08/22/2024