MEDICARE: EVERSIDE HEALTH, 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1962986489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERSIDE HEALTH, LLC

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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 EAST WINDMILL LANE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1905
Country	:	US
Telephone Number	:	702-960-4465
Fax Number	:	702-960-4468

Authorized Official
Title or Position	:	DIRECTOR OF RISK MANAGEMENT
Name	:	JILL JOHNSON PATTON
Credential	:
Telephone Number	:	704-936-5546

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	08/12/2022

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Directions to “EVERSIDE HEALTH, LLC ” Practice Location

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