Evernorth Direct Health LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EVERNORTH DIRECT HEALTH LLC

Practice address

3801 Dal Tile Rd
Muskogee, OK 74401-8204

Phone

(918) 682-2672

Fax

(918) 682-2673

NPI assigned

May 12, 2023

Organization subpart

Yes

Parent organization

EVERNORTH DIRECT HEALTH LLCAs reported in NPPES

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

Authorized official

Name

Deborah Sue Coolidge

Title

Financial Analysis Senior Manager

Phone

(623) 277-1170

Specialties & licenses 1

Addresses

Other names 1

• Mohawk HLC Muskogee Other name

Tax ID family

Evernorth Direct Health LLC102 organizations share this tax ID, including this one

Part of

Evernorth Direct Health LLC

Locations

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1740970631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8888 E RAINTREE DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 DAL TILE RD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744018204",
            "telephone_number": "918-682-2672",
            "fax_number": "918-682-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERNORTH DIRECT HEALTH LLC",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "COOLIDGE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "FINANCIAL ANALYSIS SENIOR MANAGER",
        "authorized_official_telephone_number": "623-277-1170"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohawk HLC Muskogee",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinic/Center in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; 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.