=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962008144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERSIDE HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2020
-----------------------------------------------------
Last Update Date | 03/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 N WAYNE ST
-----------------------------------------------------
City | ANGOLA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46703-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-305-2622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1433
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03802-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CENTRAL SUPPORT
-----------------------------------------------------
Name | KARLA SPIVEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-434-3255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------