Provider Demographics
NPI:1790089324
Name:E -HEALTH VENTURES, LLC
Entity Type:Organization
Organization Name:E -HEALTH VENTURES, LLC
Other - Org Name:MEDICAL SPARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-7107
Mailing Address - Street 1:2906 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4233
Mailing Address - Country:US
Mailing Address - Phone:601-594-7107
Mailing Address - Fax:
Practice Address - Street 1:2906 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4233
Practice Address - Country:US
Practice Address - Phone:601-594-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health