Provider Demographics
NPI:1518139534
Name:EVERSPRING LLC
Entity Type:Organization
Organization Name:EVERSPRING LLC
Other - Org Name:EVERSPRING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-344-9099
Mailing Address - Street 1:1884 LACKLAND HILL PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3569
Mailing Address - Country:US
Mailing Address - Phone:314-344-9094
Mailing Address - Fax:314-344-9097
Practice Address - Street 1:1884 LACKLAND HILL PKWY STE 6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3569
Practice Address - Country:US
Practice Address - Phone:314-344-9094
Practice Address - Fax:314-344-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080081823336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518139534Medicaid
MO1518139534Medicaid