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General NPI Number Information
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NPI Number | 1689655334
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Entity Type | Organization
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Legal Business Name | EVERGREEN SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 12333 NE 130TH LN SUITE 500
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City | KIRKLAND
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State | WA
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Zip | 98034-7467
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Country | US
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Telephone | 425-899-5656
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Fax | 425-899-5638
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Provider Business Mailing Address
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Address Line | 12333 NE 130TH LN SUITE 500
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City | KIRKLAND
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State | WA
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Zip | 98034-7467
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Country | US
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Telephone | 425-899-5656
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Fax | 425-899-5638
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JEFF TOMLIN
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Credential | M.D.
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Telephone | 425-899-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | WA
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