| Centerwell Senior Primary Care - Lake Charles | |
|
4050 Ryan St Lake Charles LA 70605-2820 | |
| (337) 915-0691 | |
| (877) 706-9899 |
| Full Name | Centerwell Senior Primary Care - Lake Charles |
|---|---|
| Speciality | Internal Medicine |
| Location | 4050 Ryan St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerwell Senior Primary Care - Lake Charles 4700 Millenia Blvd Ste 650 Orlando FL 32839-6013 Ph: (407) 447-7120 | Centerwell Senior Primary Care - Lake Charles 4050 Ryan St Lake Charles LA 70605-2820 Ph: (337) 915-0691 |
| NPI Number | 1952036998 |
|---|---|
| Provider Enumeration Date | 07/22/2022 |
| Last Update Date | 08/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952036998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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