Provider Demographics
NPI:1750835054
Name:EVERSIDE HEALTH, LLC
Entity Type:Organization
Organization Name:EVERSIDE HEALTH, LLC
Other - Org Name:PALADINA HEALTH MAYVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-936-5546
Mailing Address - Street 1:4651 CHARLOTTE PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1641
Practice Address - Country:US
Practice Address - Phone:866-808-6005
Practice Address - Fax:978-620-2348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVITA HEALTHCARE PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty