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NPI Code Detail

MEDICARE: EVERGREEN SURGERY CENTER, LLC

MEDICARE: EVERGREEN SURGERY CENTER, LLC
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
1261QA1903XAmbulatory Surgical Clinic/CenterWA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689655334
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERGREEN SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 12333 NE 130TH LN
Second Line : SUITE 500
City : KIRKLAND
State : WA
Zip : 98034-7467
Country : US
Telephone Number : 425-899-5656
Fax Number : 425-899-5638
Provider Business Practice Location Address
First Line : 12333 NE 130TH LN
Second Line : SUITE 500
City : KIRKLAND
State : WA
Zip : 98034-7467
Country : US
Telephone Number : 425-899-5656
Fax Number : 425-899-5638
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. JEFF TOMLIN
Credential : M.D.
Telephone Number : 425-899-5656
Provider Enumeration Date : 11/09/2005
Last Update Date : 09/20/2007

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Directions to “EVERGREEN SURGERY CENTER, LLC ” Practice Location

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