Organization
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Active
Parent organization
PARTNERS IN PRIMARY CARE TX, PA
Other names
Partners in Primary Care KS, PA, Partners In Primary Care TX, PA, CenterWell Senior Primary Care - Port Arthur, Partners In Primary Care- Port Arthur
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARTNERS IN PRIMARY CARE TX, PA
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
8555 MEMORIAL BLVD STE 100, PORT ARTHUR, TX 77640-7001
(409) 237-6480
(833) 749-0330
Mailing address
4700 MILLENIA BLVD STE 650, ORLANDO, FL 32839-6013
(407) 447-7120
(407) 770-0661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1C6598
MEDICARE
TX
05
—
4179707-01
—
TX
Enumeration date
02/11/2020
Last updated
10/18/2022
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