Provider Demographics
NPI:1073262408
Name:EVERNORTH CARE PROVIDERS - DELAWARE PA
Entity Type:Organization
Organization Name:EVERNORTH CARE PROVIDERS - DELAWARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SR. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-292-4800
Mailing Address - Street 1:730 COOL SPRINGS BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7331
Mailing Address - Country:US
Mailing Address - Phone:312-292-4800
Mailing Address - Fax:312-569-4059
Practice Address - Street 1:1201 NW BRIARCLIFF PKWY FL 2
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1878
Practice Address - Country:US
Practice Address - Phone:773-292-4800
Practice Address - Fax:312-564-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty