Organization
CENTERWELL SENIOR PRIMARY CARE MS PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE MS PC
Other names
CenterWell Senior Primary Care-Jackson West
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE MS PC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
4890 HIGHWAY 18 W, JACKSON, MS 39209-9666
(407) 447-7120
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
11/28/2023
Last updated
07/03/2024
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