Centerwell Senior Primary Care Ms PC
Internal Medicine in Jackson, MS. Organization (NPI-2).
NPI number1710693619
StatusActive
Last updated in NPPESJul 3, 2024
Details
- NPI
- 1710693619
- Entity type
- Organization (NPI-2)
- Legal business name
- Centerwell Senior Primary Care Ms PC
- Organization subpart
- Yes
- Enumeration date
- Jan 25, 2023
- Certification date
- Jul 3, 2024
- Last updated
- Jul 3, 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-Jackson East (Doing Business As)
Practice location
1220 E Northside Dr Ste 220Jackson, MS 39211-5503
Phone 601-298-4173 · Fax 877-866-2356
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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