Provider Demographics
NPI:1902670870
Name:EVERWELL MEDICAL ,LLC
Entity Type:Organization
Organization Name:EVERWELL MEDICAL ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KO SAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-609-5763
Mailing Address - Street 1:2464 OLD FORT PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4163
Mailing Address - Country:US
Mailing Address - Phone:615-410-3137
Mailing Address - Fax:615-410-3427
Practice Address - Street 1:2464 OLD FORT PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4163
Practice Address - Country:US
Practice Address - Phone:615-410-3137
Practice Address - Fax:615-410-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder