Organization
CENTERWELL SENIOR PRIMARY CARE (LA) PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE (LA) PC
Other names
CenterWell Senior Primary Care - Lake Charles
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE (LA) PC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING SPECIALIST)
(407) 447-7120
Entity
Organization
Contact information
Practice address
4050 RYAN ST, LAKE CHARLES, LA 70605-2820
(337) 915-0691
(877) 706-9899
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
07/22/2022
Last updated
08/11/2023
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