Healthcare Provider Details

I. General information

NPI: 1366884983
Provider Name (Legal Business Name): EVERGREEN TECHNICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6539 S COTTONWOOD ST
MURRAY UT
84107-7007
US

IV. Provider business mailing address

6539 S COTTONWOOD ST
MURRAY UT
84107-7007
US

V. Phone/Fax

Practice location:
  • Phone: 801-290-2442
  • Fax:
Mailing address:
  • Phone: 801-290-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number152474117
License Number StateUT

VIII. Authorized Official

Name: TAUNIA J LINDLEY
Title or Position: OWNER
Credential:
Phone: 801-290-2442