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25D2278609 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - GULFPORT

Laboratory Demographics

CLIA Number: 25D2278609

Facility Name: CENTERWELL SENIOR PRIMARY CARE - GULFPORT

Facility Address:
12057 US HWY 49 STE C
GULFPORT, MS
ZIP 39503
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Facility Phone Number: 228 832-9385

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1003528092

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 25D2278609
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - GULFPORT
Street 12057 US HWY 49 STE C
City GULFPORT
State MS
ZIP 39503
Phone 228 832-9385
CertificateType 4
CertificateEffectiveDate 3/21/2023
CertificateExpirationDate 3/20/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024