1174874200 NPI number — EVERNORTH CARE PROVIDERS - NEW JERSEY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174874200 NPI number — EVERNORTH CARE PROVIDERS - NEW JERSEY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERNORTH CARE PROVIDERS - NEW JERSEY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174874200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 COOL SPRINGS BLVD STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-7331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-292-4800
Provider Business Mailing Address Fax Number:
312-564-4059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 RIVERVIEW DR FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOTOWA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07512-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-292-4800
Provider Business Practice Location Address Fax Number:
312-564-4059
Provider Enumeration Date:
09/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAKES
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SENIOR PARALEGAL
Authorized Official Telephone Number:
954-446-0640

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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