MEDICARE: EVERSIDE HEALTH LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1174319800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERSIDE HEALTH LLC

Provider Business Mailing Address
First Line	:	10 W MARKET ST STE 2900
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 INDUSTRIAL WAY
Second Line	:
City	:	CROTHERSVILLE
State	:	IN
Zip	:	47229-9415
Country	:	US
Telephone Number	:	812-405-2039
Fax Number	:

Authorized Official
Title or Position	:	CENTRAL SUPPORT SPECIALIST
Name	:	KARLA SPIVEY
Credential	:
Telephone Number	:	317-869-3164

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	04/18/2025

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Directions to “EVERSIDE HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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