Organization
EVERSIDE HEALTH, LLC
Active
Parent organization
DAVITA DPC HOLDING, INC
Other names
Everside Health - Pueblo Fortino Blvd
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA DPC HOLDING, INC
Authorized official
JILL JOHNSON PATTON (DIRECTOR OF RISK MANAGEMENT)
(704) 936-5546
Entity
Organization
Contact information
Practice address
1300 FORTINO BLVD STE C, PUEBLO, CO 81008-2078
(719) 404-5100
Mailing address
4651 CHARLOTTE PARK DR STE 300, CHARLOTTE, NC 28217-1916
(866) 808-6005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/13/2015
Last updated
08/11/2022
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