Provider Demographics
NPI:1699399519
Name:EVOLVE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-387-1403
Mailing Address - Street 1:201 19TH ST E STE B
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5457
Mailing Address - Country:US
Mailing Address - Phone:205-387-1403
Mailing Address - Fax:205-387-1418
Practice Address - Street 1:201 19TH ST E STE B
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5457
Practice Address - Country:US
Practice Address - Phone:205-387-1403
Practice Address - Fax:205-387-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty