Organization · NPI-2

Centerwell Senior Primary Care (La) PC

Internal Medicine · Opelousas, LA

NPI number1407564628
StatusActive
Last updated in NPPESAug 22, 2024

Details

NPI
1407564628
Entity type
Organization (NPI-2)
Legal business name
Centerwell Senior Primary Care (La) PC
Organization subpart
Yes
Enumeration date
Nov 7, 2022
Certification date
Aug 22, 2024
Last updated
Aug 22, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes
207Q00000X Family Medicine––
208D00000X General Practice––

Other names

  • Centerwell Senior Primary Care-Opelousas (Doing Business As)

Practice location

1511 Commerce Blvd Ste 6
Opelousas, LA 70570-2063

Phone 337-381-2033 · Fax 877-258-1537

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168

Phone 305-500-2000

Authorized official

Angie Martinez
Senior Credentialing Professional
4074477120

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