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General NPI Number Information
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NPI Number | 1568434025
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Entity Type | Organization
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Legal Business Name | EVERGREEN FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1937 W HARVARD AVE
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City | ROSEBURG
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State | OR
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Zip | 97471-2720
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Country | US
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Telephone | 541-677-7200
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Fax | 541-229-3309
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Provider Business Mailing Address
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Address Line | 2570 NW EDENBOWER BLVD STE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-6214
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Country | US
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Telephone | 541-677-7200
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Fax | 541-677-3309
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Authorized Official
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Title or Position | COO
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Name | MRS. KIMBERLY TYREE
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Credential |
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Telephone | 541-229-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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