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NPI Code Detail

MEDICARE: EVERSIDE HEALTH, LLC

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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1992269336
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERSIDE HEALTH, LLC
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 : 2739 SUNRIDGE HEIGHTS PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5043
Country : US
Telephone Number : 702-728-5806
Fax Number : 702-728-5807
Authorized Official
Title or Position : DIRECTOR OF RISK MANAGEMENT
Name : JILL JOHNSON PATTON
Credential :
Telephone Number : 704-936-5546
Provider Enumeration Date : 01/30/2019
Last Update Date : 03/30/2023

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Directions to “EVERSIDE HEALTH, LLC ” Practice Location

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