Healthcare Provider Details

I. General information

NPI: 1063063089
Provider Name (Legal Business Name): EVERNORTH DIRECT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14311 METROPOLIS AVE STE 102
FORT MYERS FL
33912-4442
US

IV. Provider business mailing address

25600 N NORTERRA DR
PHOENIX AZ
85085-8201
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-0127
  • Fax: 239-768-0671
Mailing address:
  • Phone: 623-277-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH SUE COOLIDGE
Title or Position: FINANCIAL ANALYSIS SENIOR MANAGER
Credential:
Phone: 623-277-1170