| Centerwell Senior Primary Care Of West Vine | |
|
3185 W Vine St Kissimmee FL 34741-3738 | |
| (407) 569-1260 | |
| (833) 963-0109 |
| Full Name | Centerwell Senior Primary Care Of West Vine |
|---|---|
| Speciality | Internal Medicine |
| Location | 3185 W Vine St, Kissimmee, Florida |
| 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 Of West Vine 4700 Millenia Blvd Ste 650 Orlando FL 32839-6013 Ph: (407) 447-7120 | Centerwell Senior Primary Care Of West Vine 3185 W Vine St Kissimmee FL 34741-3738 Ph: (407) 569-1260 |
| NPI Number | 1811548399 |
|---|---|
| Provider Enumeration Date | 09/25/2019 |
| Last Update Date | 05/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811548399 | NPI | - | NPPES |
| 019084135 | Medicaid | FL |
| 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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