Organization
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Other names
CenterWell Senior Primary care- Redbird
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
3209 W CAMP WISDOM RD, DALLAS, TX 75237-2605
(469) 966-9660
(877) 667-6112
Mailing address
4700 MILLENIA BLVD STE 650, ORLANDO, FL 32839-6013
(407) 447-7120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
02/11/2022
Last updated
10/18/2022
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