MEDICARE: EVERGREEN PROFESSIONAL BILLING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1932041365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN PROFESSIONAL BILLING

Provider Business Mailing Address
First Line	:	16455 S HARDING RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-9678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16455 S HARDING RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-9678
Country	:	US
Telephone Number	:	503-998-5841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY AVERY
Credential	:
Telephone Number	:	503-998-5841

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “EVERGREEN PROFESSIONAL BILLING ” Practice Location

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