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
121 SW MORRISON ST STE 525, PORTLAND, OR 97204-3247
(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
08/09/2023
Last updated
08/09/2023
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