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General NPI Number Information
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NPI Number | 1225572092
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Entity Type | Organization
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Legal Business Name | EVERSIDE HEALTH, LLC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 213 NOLAN PARKWAY
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City | ARCHBOLD
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State | OH
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Zip | 43502-8404
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Country | US
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Telephone | 567-444-4840
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Fax | 567-444-4850
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Provider Business Mailing Address
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Address Line | 4651 CHARLOTTE PARK DR STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28217-1916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OR RISK MANAGEMENT
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Name | JILL JOHNSON PATTON
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Credential |
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Telephone | 704-936-5546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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