MEDICARE: EVERSTONE RIDGE 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1588502439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERSTONE RIDGE LLC

Provider Business Mailing Address
First Line	:	9729 GAYNOR CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3098
Country	:	US
Telephone Number	:	833-412-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	9729 GAYNOR CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3098
Country	:	US
Telephone Number	:	833-412-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAMMAD KHAN
Credential	:
Telephone Number	:	833-412-3636

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “EVERSTONE RIDGE LLC ” Practice Location

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