Provider Demographics
NPI:1528679586
Name:EVEREST HEALTHCARE INC
Entity type:Organization
Organization Name:EVEREST HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SEMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AJSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-2862
Mailing Address - Street 1:1815 BACK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2159
Mailing Address - Country:US
Mailing Address - Phone:704-904-2862
Mailing Address - Fax:704-716-7801
Practice Address - Street 1:224 EGLIN PKWY NE STE E
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2877
Practice Address - Country:US
Practice Address - Phone:850-215-4856
Practice Address - Fax:877-544-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory