MEDICARE: EVERNORTH DIRECT 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1790481091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERNORTH DIRECT HEALTH LLC

Provider Business Mailing Address
First Line	:	8888 E RAINTREE DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 LAFAYETTE HWY
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-7250
Country	:	US
Telephone Number	:	334-863-7410
Fax Number	:	334-863-7415

Authorized Official
Title or Position	:	FINANCIAL ANALYSIS SENIOR MANAGER
Name	:	DEBORAH SUE COOLIDGE
Credential	:
Telephone Number	:	623-277-1170

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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Directions to “EVERNORTH DIRECT HEALTH LLC ” Practice Location

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