| Evernorth Care Providers - Delaware Pa | |
|
1500 K St Nw Fl 2 Washington DC 20005-1209 | |
| (773) 292-4800 | |
| (312) 564-4059 |
| Full Name | Evernorth Care Providers - Delaware Pa |
|---|---|
| Speciality | General Practice |
| Location | 1500 K St Nw Fl 2, Washington, District Of Columbia |
| 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 - Delaware Pa 730 Cool Springs Blvd Ste 500 Franklin TN 37067-7331 Ph: (773) 292-4800 | Evernorth Care Providers - Delaware Pa 1500 K St Nw Fl 2 Washington DC 20005-1209 Ph: (773) 292-4800 |
| NPI Number | 1578330684 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 12/08/2023 |
| Medicare PECOS PAC ID | 6002217973 |
|---|---|
| Medicare Enrollment ID | O20240320003413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578330684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Chantal D Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487817466 PECOS PAC ID: 6305982455 Enrollment ID: I20091005000216 |
| Provider Name | Adetutu Aina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710317680 PECOS PAC ID: 8820317829 Enrollment ID: I20180220001243 |
| Provider Name | Musu N Komeyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730752486 PECOS PAC ID: 1355702804 Enrollment ID: I20230731001777 |
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