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	:	1841182821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERSIDE HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 1433
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03802-1433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7189
Country	:	US
Telephone Number	:	725-745-4646
Fax Number	:

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

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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Directions to “EVERSIDE HEALTH LLC ” Practice Location

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