Centerwell Senior Primary Care (Tx) PA
Internal Medicine in Desoto, TX. Organization (NPI-2).
NPI number1689491581
StatusActive
Last updated in NPPESDec 17, 2024
Details
- NPI
- 1689491581
- Entity type
- Organization (NPI-2)
- Legal business name
- Centerwell Senior Primary Care (Tx) PA
- Organization subpart
- Yes
- Enumeration date
- Sep 23, 2024
- Certification date
- Dec 17, 2024
- Last updated
- Dec 17, 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- Desoto (Doing Business As)
Practice location
951 W Belt Line Rd Ste 100Desoto, TX 75115-3737
Phone 972-734-8092 · Fax 214-306-8192
Mailing address
6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168
Phone 407-447-7120 · Fax 407-770-0661
Authorized official
Angie Martinez
Senior Credentialing Professional
4074477120
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