MEDICARE: EV COLLABORATIVE HOUSE CALLS LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1821696246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EV COLLABORATIVE HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	16325 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1233
Country	:	US
Telephone Number	:	346-270-3648
Fax Number	:

Provider Business Practice Location Address
First Line	:	16325 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1233
Country	:	US
Telephone Number	:	346-270-3648
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIVIAN ELEGE
Credential	:	NP
Telephone Number	:	346-270-3648

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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Directions to “EV COLLABORATIVE HOUSE CALLS LLC ” Practice Location

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