MEDICARE: EVERSIDE HEALTH AT NTN COLUMBUS INTERNATIONAL DR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician

General Provider Information

NPI Number	:	1174204754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERSIDE HEALTH AT NTN COLUMBUS INTERNATIONAL DR

Provider Business Mailing Address
First Line	:	4651 CHARLOTTE PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 S INTERNATIONAL DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-9329
Country	:	US
Telephone Number	:	704-661-1380
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF RISK MANAGEMENT
Name	:	JILL JOHNSON PATTON
Credential	:
Telephone Number	:	704-936-5546

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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