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49D2300070 CLIA NUMBER - EVERNORTH CARE PROVIDERS-TENNESSEE PC

Laboratory Demographics

CLIA Number: 49D2300070

Facility Name: EVERNORTH CARE PROVIDERS-TENNESSEE PC

Facility Address:
11350 RANDOM HILLS RD, SUITE 800
FAIRFAX, VA
ZIP 22030
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Facility Phone Number: 877 663-1333

Facility Type: Other - IN HOME PRIMARY CARE

Certificate Type: Waiver
NPI Number: 1174304976

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name Field Value
CLIA Number 49D2300070
LAB Type Other - IN HOME PRIMARY CARE
Facility Name EVERNORTH CARE PROVIDERS-TENNESSEE PC
Street 11350 RANDOM HILLS RD, SUITE 800
City FAIRFAX
State VA
ZIP 22030
Phone 877 663-1333
CertificateType 4
CertificateEffectiveDate 3/4/2024
CertificateExpirationDate 3/3/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024