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CenterWell Senior Primary Care (MS) CS, P.C.

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Company Details

Name: CenterWell Senior Primary Care (MS) CS, P.C.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 11 Feb 2025 (6 months ago)
Business ID: 1476124
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 645 LAKELAND EAST DRIVE STE 101, FLOWOOD, MS 39232

Incorporator

Name Role Address
Erica Savage-Jeter Incorporator 500 west main street, Louisville, KY 40202

National Provider Identifier

NPI Number:
1730980434
Certification Date:
2025-04-23

Authorized Person:

Name:
ANGIE MARTINEZ
Role:
SENIOR CREDENTIALING PROFESSIONAL
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
4077700661

Filings

Type Status Filed Date Description
Formation Form Filed 2025-02-11 Formation For CenterWell Senior Primary Care (MS) CS, P.C.

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Date of last update: 03 Aug 2025

Sources: Company Profile on Mississippi Secretary of State Website