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General NPI Number Information
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NPI Number | 1740970631
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Entity Type | Organization
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Legal Business Name | EVERNORTH DIRECT HEALTH LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 3801 DAL TILE RD
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City | MUSKOGEE
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State | OK
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Zip | 74401-8204
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Country | US
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Telephone | 918-682-2672
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Fax | 918-682-2673
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Provider Business Mailing Address
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Address Line | 8888 E RAINTREE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3951
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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 | FINANCIAL ANALYSIS SENIOR MANAGER
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Name | DEBORAH SUE COOLIDGE
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Credential |
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Telephone | 623-277-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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