Provider Demographics
NPI:1316744998
Name:EVERMAN FAMILY MEDICINE
Entity type:Organization
Organization Name:EVERMAN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:EVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-830-3156
Mailing Address - Street 1:484 E LOCKHART LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6580
Mailing Address - Country:US
Mailing Address - Phone:208-830-3156
Mailing Address - Fax:
Practice Address - Street 1:4771 N SUMMIT WAY STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5017
Practice Address - Country:US
Practice Address - Phone:208-830-3156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty