| Centerwell Senior Primary Care-gulfport | |
|
12057 Highway 49 Ste C Gulfport MS 39503-3177 | |
| (228) 832-9385 | |
| (877) 504-6444 |
| Full Name | Centerwell Senior Primary Care-gulfport |
|---|---|
| Speciality | Internal Medicine |
| Location | 12057 Highway 49 Ste C, Gulfport, Mississippi |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerwell Senior Primary Care-gulfport 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | Centerwell Senior Primary Care-gulfport 12057 Highway 49 Ste C Gulfport MS 39503-3177 Ph: (228) 832-9385 |
| NPI Number | 1003528092 |
|---|---|
| Provider Enumeration Date | 12/21/2022 |
| Last Update Date | 07/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003528092 | 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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