Evernorth Direct Health LLC
Organization Active NPI Clinic/Center · Bridgeport, AL
NPI 1245920131 · NPPES record last updated May 12, 2023
Key facts
- NPI
- 1245920131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- EVERNORTH DIRECT HEALTH LLC
- Practice address
- 202 Jacobs Ave
Bridgeport, AL 35740-6682 - Phone
- (256) 495-2928
- Fax
- (256) 495-2928
- NPI assigned
- May 12, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- EVERNORTH DIRECT HEALTH LLC
Authorized official
- Name
- Deborah Sue Coolidge
- Title
- Financial Analysis Senior Manager
- Phone
- (623) 277-1170
Corporate family (same tax ID) 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2156953 | Evernorth Direct Health LLC | Certificate of waiver | Oct 28, 2026 |
National Provider Directory
- Tax ID family
- Evernorth Direct Health LLC
- Part of
- Evernorth Direct Health LLC
Locations
202 Jacobs Ave
Bridgeport, AL 35740
Phone (256) 495-2928
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
202 Jacobs Ave
Bridgeport, AL 35740-6682
Mailing address
8888 E Raintree Dr
Scottsdale, AZ 85260-3951
Other names
- Mohawk HLC Bridgeport
Other providers in Bridgeport, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.