Healthcare Provider Details

I. General information

NPI: 1437998309
Provider Name (Legal Business Name): EVENTUS PREMIER HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BROWNS HILL CT
MIDLOTHIAN VA
23114-9510
US

IV. Provider business mailing address

PO BOX 1431 DEPT 380
CHARLOTTE NC
28201-1431
US

V. Phone/Fax

Practice location:
  • Phone: 980-271-2563
  • Fax:
Mailing address:
  • Phone: 844-932-5700
  • Fax: 512-792-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY GOAD
Title or Position: OWNER
Credential: DO
Phone: 844-932-5700