| Name: | Evernorth Care Providers - Delaware PA |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 09 Jan 2024 (a year ago) |
| Identification Number: | 001767608 |
| ZIP code: | 02903 |
| County: | Providence County |
| Place of Formation: | DELAWARE |
| Principal Address: | 10 DORRANCE STREET SUITE 700, PROVIDENCE, RI, 02903, USA |
| Purpose: | THE PRACTICE OF MEDICINE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790548949 | 2024-01-31 | 2024-01-31 | 730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN, 370677331, US | 10 DORRANCE ST STE 700, PROVIDENCE, RI, 029032014, US | |||||||||||||||
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| Phone | +1 773-292-4800 |
| Fax | 3125644059 |
Authorized person
| Name | GRACE BLUE |
| Role | CREDENTIALING SR. MANAGER |
| Phone | 7732924800 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 450 VETERANS MEMORIAL PARKWAY SUITE 7A, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| SHANNON ALSOP DO | PRESIDENT | 730 COOL SPRINGS BOULEVARD, SUITE 500 FRANKLIN, TN 37067 USA |
| Number | Name | File Date |
|---|---|---|
| 202443855410 | Application for Certificate of Authority | 2024-01-09 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
