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General NPI Number Information
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NPI Number | 1376329060
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Entity Type | Organization
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Legal Business Name | EVERSIDE HEALTH CA IRONWORKERS LAS VEGAS
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1815 E LAKE MEAD BLVD STE 210
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-7189
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Country | US
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Telephone | 704-661-1380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1433
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City | PORTSMOUTH
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State | NH
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Zip | 03802-1433
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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