NPIMap

Organization Active NPI

Evernorth Direct Health LLC

Doing business as Mohawk -Tx- Dal Tile Sunnyvale

  • Non-Pharmacy Dispensing Site
  • Sunnyvale, TX
National Provider Identifier
1134552508
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
AP121686 Issued in TX
Legal business name
EVERNORTH DIRECT HEALTH LLC
Doing business as
Mohawk -Tx- Dal Tile Sunnyvale
Practice address
199 Planters Rd
Sunnyvale, TX 75182-9601
Phone
(214) 309-3438
NPI assigned
Aug 20, 2013
Last updated
May 3, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X AP121686 TX Primary

Addresses

Primary practice location

199 Planters Rd
Sunnyvale, TX 75182-9601

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • Mohawk -Tx- Dal Tile Sunnyvale Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Direct Health LLC104 organizations share this tax ID, including this one
Part of
Medvantx Inc

Organizations with this tax ID in the same state 8

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1134552508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 PLANTERS RD",
            "city": "SUNNYVALE",
            "state": "TX",
            "postal_code": "751829601",
            "telephone_number": "214-309-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-08-20",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "TX",
            "license": "AP121686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohawk -Tx- Dal Tile Sunnyvale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mohawk -Tx- Dal Tile Sunnyvale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sunnyvale, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.