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NPI Code Detail

MEDICARE: EVERSIDE HEALTH CENTER-MICHELIN LEXINGTON

MEDICARE: EVERSIDE HEALTH CENTER-MICHELIN LEXINGTON
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
12083P0500XPreventive Medicine/Occupational Environmental Medicine Physician

General Provider Information

NPI Number : 1942977608
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERSIDE HEALTH CENTER-MICHELIN LEXINGTON
Provider Business Mailing Address
First Line : 4651 CHARLOTTE PARK DR STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28217-1916
Country : US
Telephone Number : 704-936-5546
Fax Number :
Provider Business Practice Location Address
First Line : 2480 TWO NOTCH RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7963
Country : US
Telephone Number : 803-951-5871
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF RISK MANAGEMENT
Name : JILL JOHNSON PATTON
Credential :
Telephone Number : 704-936-5546
Provider Enumeration Date : 08/30/2021
Last Update Date : 12/01/2021

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Directions to “EVERSIDE HEALTH CENTER-MICHELIN LEXINGTON ” Practice Location

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