MEDICARE: EVOLENT SPECIALTY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124214549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLENT SPECIALTY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1812 N MOORE ST STE 1705
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N MOORE ST STE 1705
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1811
Country	:	US
Telephone Number	:	888-999-7713
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT PRITCHARD
Credential	:
Telephone Number	:	866-753-0046

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	10/31/2024

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