Provider Demographics
NPI:1477583326
Name:EVANS TOTAL CARE, LLC
Entity Type:Organization
Organization Name:EVANS TOTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:270-472-2984
Mailing Address - Street 1:208 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-1544
Mailing Address - Country:US
Mailing Address - Phone:270-472-2984
Mailing Address - Fax:270-472-9377
Practice Address - Street 1:208 LAKE ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1544
Practice Address - Country:US
Practice Address - Phone:270-472-2984
Practice Address - Fax:270-472-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0530332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000298324OtherANTHEM BCBS
TN1454274Medicaid
KY90005596Medicaid
TN4067258OtherBCBS TN
4661190001Medicare ID - Type Unspecified