Provider Demographics
NPI:1326889056
Name:EVERSIDE HEALTH LLC
Entity type:Organization
Organization Name:EVERSIDE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMPLEMENTATION AND ONBOARDING COORD
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-869-3164
Mailing Address - Street 1:10 W MARKET ST STE 2900
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2964
Mailing Address - Country:US
Mailing Address - Phone:317-869-3164
Mailing Address - Fax:
Practice Address - Street 1:9493 N FORT WASHINGTON RD STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0637
Practice Address - Country:US
Practice Address - Phone:559-550-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center