Healthcare Provider Details

I. General information

NPI: 1982150355
Provider Name (Legal Business Name): EVERSIDE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 S MOORLAND RD
NEW BERLIN WI
53151-5145
US

IV. Provider business mailing address

1400 WEWATTA ST STE 350
DENVER CO
80202-5553
US

V. Phone/Fax

Practice location:
  • Phone: 414-306-6651
  • Fax: 978-291-1897
Mailing address:
  • Phone: 866-808-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL JOHNSON PATTON
Title or Position: DIRECTOR OF RISK MANAGEMENT
Credential:
Phone: 704-936-5546