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General NPI Number Information
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NPI Number | 1588790562
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Entity Type | Organization
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Legal Business Name | EVERGREEN FAMILY HEALTH PARTNERS
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 426 INDUSTRIAL AVE STE 130
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City | WILLISTON
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State | VT
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Zip | 05495-4449
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Country | US
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Telephone | 802-878-1008
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Fax | 802-872-2679
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Provider Business Mailing Address
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Address Line | 426 INDUSTRIAL AVE STE 130
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City | WILLISTON
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State | VT
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Zip | 05495-4449
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Country | US
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Telephone | 802-878-1008
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Fax | 802-872-2679
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. KATRINA PAYEA
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Credential |
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Telephone | 802-878-1008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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