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General NPI Number Information
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NPI Number | 1366115768
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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 | 07/30/2021
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 2060 US HIGHWAY 52 W STE S
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-5472
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Country | US
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Telephone | 765-222-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W MARKET ST STE 2900
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2964
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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 | CENTRAL SUPPORT SPECIALIST
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Name | KARLA SPIVEY
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Credential |
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Telephone | 317-869-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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