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Organization
CENTERWELL SENIOR PRIMARY CARE MS CS PC
Active
Organization
CENTERWELL SENIOR PRIMARY CARE MS CS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
2650 BEACH BLVD STE 40, BILOXI, MS 39531-4517
(407) 447-7120
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(407) 447-7120
(407) 770-0661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/20/2025
Last updated
04/23/2025
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