| Evernorth Care Providers - Arizona Pc | |
|
2850 W Horizon Ridge Pkwy Ste 200 Henderson NV 89052-4395 | |
| (773) 292-4800 | |
| (312) 564-4059 |
| Full Name | Evernorth Care Providers - Arizona Pc |
|---|---|
| Speciality | General Practice |
| Location | 2850 W Horizon Ridge Pkwy Ste 200, Henderson, Nevada |
| Authorized Official Name and Position | Grace Blue (CREDENTIALING SR. MANAGER) |
| Authorized Official Contact | 7732924800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evernorth Care Providers - Arizona Pc 730 Cool Springs Blvd Ste 500 Franklin TN 37067-7331 Ph: (773) 292-4800 | Evernorth Care Providers - Arizona Pc 2850 W Horizon Ridge Pkwy Ste 200 Henderson NV 89052-4395 Ph: (773) 292-4800 |
| NPI Number | 1891565123 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 01/08/2024 |
| Medicare PECOS PAC ID | 6002268455 |
|---|---|
| Medicare Enrollment ID | O20240202002861 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891565123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Shannon Alsop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003043803 PECOS PAC ID: 7517121742 Enrollment ID: I20240327001554 |
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