Organization
EVERNORTH CARE PROVIDERS - ARIZONA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE BLUE (CREDENTIALING SR. MANAGER)
(773) 292-4800
Entity
Organization
Contact information
Practice address
101 S REID ST STE 307, SIOUX FALLS, SD 57103-7045
(773) 292-4800
(312) 564-4059
Mailing address
730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN 37067-7331
(773) 292-4800
(312) 564-4059
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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