MEDICARE: EVERGREEN TECHNICAL SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	152474117	UT

General Provider Information

NPI Number	:	1366884983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN TECHNICAL SERVICES INC

Provider Business Mailing Address
First Line	:	6539 S COTTONWOOD ST
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-7007
Country	:	US
Telephone Number	:	801-290-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	6539 S COTTONWOOD ST
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-7007
Country	:	US
Telephone Number	:	801-290-2442
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAUNIA J LINDLEY
Credential	:
Telephone Number	:	801-290-2442

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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Directions to “EVERGREEN TECHNICAL SERVICES INC ” Practice Location

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