1447717871 NPI number — CENTERWELL SENIOR PRIMARY CARE (TX) PA

Table of content: (NPI 1447717871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447717871 NPI number — CENTERWELL SENIOR PRIMARY CARE (TX) PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERWELL SENIOR PRIMARY CARE (TX) PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARTNERS IN PRIMARY CARE- DOWNTOWN EAST
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447717871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 MILLENIA BLVD STE 650
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32839-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-447-7120
Provider Business Mailing Address Fax Number:
407-770-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5104 HARRISBURG BLVD STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77011-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-667-4150
Provider Business Practice Location Address Fax Number:
833-853-9420
Provider Enumeration Date:
02/21/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR CREDENTIALING PROFESSIONAL
Authorized Official Telephone Number:
407-447-7120

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 792121 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4089997-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".