Evernorth Direct Health LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EVERNORTH DIRECT HEALTH LLC

Practice address

262 Cottage St
Springfield, MA 01104-3274

Phone

(623) 277-1190

NPI assigned

Jul 11, 2019

Organization subpart

No

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

• American Outdoor Brand Other name

Tax ID family

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

Locations

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1851943732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 COTTAGE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011043274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 COTTAGE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011043274",
            "telephone_number": "623-277-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "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": "American Outdoor Brand",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "American Outdoor Brand",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinic/Center in Springfield, MA
• Providers in Springfield, MA by specialty
• Clinic/Center in Massachusetts

• 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.