Healthcare Provider Details

I. General information

NPI: 1023796307
Provider Name (Legal Business Name): EVENTUS WHOLEHEALTH ACO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CABARRUS AVE E STE 200
CONCORD NC
28025-3781
US

IV. Provider business mailing address

PO BOX 5779
CAROL STREAM IL
60197-5779
US

V. Phone/Fax

Practice location:
  • Phone: 855-743-2247
  • Fax: 855-857-7333
Mailing address:
  • Phone: 855-743-2247
  • Fax: 855-857-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEORGE HALL
Title or Position: OWNER
Credential: MD
Phone: 855-743-2247