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General NPI Number Information
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NPI Number | 1619912524
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Entity Type | Organization
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Legal Business Name | EVERGREEN EMERGENCY SERVICES, PS
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 12040 NE 128TH ST
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City | KIRKLAND
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State | WA
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Zip | 98034-3013
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Country | US
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Telephone | 206-550-5253
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 50421
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone | 855-691-9890
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD CRYSTAL
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Credential | MD
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Telephone | 425-899-1751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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