Centerwell Senior Primary Care (La) PC
Internal Medicine in Covington, LA. Organization (NPI-2).
NPI number1326620626
StatusActive
Last updated in NPPESAug 22, 2024
Details
- NPI
- 1326620626
- Entity type
- Organization (NPI-2)
- Legal business name
- Centerwell Senior Primary Care (La) PC
- Organization subpart
- No
- Enumeration date
- Apr 26, 2021
- Certification date
- Aug 22, 2024
- Last updated
- Aug 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 208D00000X | General Practice | – | – |
Other names
- Centerwell Senior Primary Care-Covington (Doing Business As)
Practice location
66 Park Place DrCovington, LA 70433-5183
Phone 985-875-5459 · Fax 877-872-3840
Mailing address
6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168
Phone 305-500-2000
Authorized official
Angie Martinez
Senior Credentialing Professional
4074477120
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