| Centerwell Senior Primary Care- Independence | |
|
19401 E 39th St S Independence MO 64057-2308 | |
| (816) 490-4277 | |
| (855) 446-7160 |
| Full Name | Centerwell Senior Primary Care- Independence |
|---|---|
| Speciality | Internal Medicine |
| Location | 19401 E 39th St S, Independence, Missouri |
| 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- Independence 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | Centerwell Senior Primary Care- Independence 19401 E 39th St S Independence MO 64057-2308 Ph: (816) 490-4277 |
| NPI Number | 1649793001 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649793001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| 208D00000X | General Practice | () | Secondary |
| 332900000X | Non-pharmacy Dispensing Site | () | Secondary |
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