Centerwell Senior Primary Care-biloxi | |
2650 Beach Blvd Ste 40 Biloxi MS 39531-4517 | |
(228) 273-4611 | |
(877) 258-1526 |
Full Name | Centerwell Senior Primary Care-biloxi |
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Speciality | Internal Medicine |
Location | 2650 Beach Blvd Ste 40, Biloxi, Mississippi |
Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
Authorized Official Contact | 4074477120 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Centerwell Senior Primary Care-biloxi 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | Centerwell Senior Primary Care-biloxi 2650 Beach Blvd Ste 40 Biloxi MS 39531-4517 Ph: (228) 273-4611 |
NPI Number | 1841902830 |
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Provider Enumeration Date | 12/21/2022 |
Last Update Date | 07/03/2024 |
Medicare PECOS PAC ID | 0143694190 |
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Medicare Enrollment ID | O20230315000489 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841902830 | 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 |
Provider Name | Lara J Teal Clement |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912933672 PECOS PAC ID: 9032198858 Enrollment ID: I20040715000949 |
Provider Name | Lauren Gaters |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861969305 PECOS PAC ID: 4385998046 Enrollment ID: I20181115000941 |
Provider Name | Ashley Croom |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295396661 PECOS PAC ID: 5496183170 Enrollment ID: I20200311000945 |
Provider Name | Mitchell A Sanford |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346726098 PECOS PAC ID: 7719302975 Enrollment ID: I20211213002807 |
Provider Name | Timothy H Sanford |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992819197 PECOS PAC ID: 9335229269 Enrollment ID: I20211213002828 |
Provider Name | Earl Kyle Magee |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1508887977 PECOS PAC ID: 9537152475 Enrollment ID: I20230315000600 |
Provider Name | Michaela Cheyenne Wells |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386269629 PECOS PAC ID: 3476930793 Enrollment ID: I20230413002675 |
Provider Name | Colleen Phillips |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1114532314 PECOS PAC ID: 1951777184 Enrollment ID: I20230725004233 |
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