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General NPI Number Information
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NPI Number | 1659948271
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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 | 06/10/2021
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 1405 E MARKET ST
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City | NAPPANEE
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State | IN
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Zip | 46550-2303
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Country | US
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Telephone | 866-808-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 WEWATTA ST STE 350
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City | DENVER
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State | CO
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Zip | 80202-5553
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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 OF 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 | 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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