MEDICARE: EVERGREEN MEDICAL PRACTICE, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	103TC1900X	Counseling Psychologist
4	2084P0800X	Psychiatry Physician
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1982551826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN MEDICAL PRACTICE, P.C.

Provider Business Mailing Address
First Line	:	371 NE GILMAN BLVD FL 1
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2901
Country	:	US
Telephone Number	:	206-257-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 NE GILMAN BLVD FL 1
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2901
Country	:	US
Telephone Number	:	206-257-3231
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN SNIPES
Credential	:	MD
Telephone Number	:	213-827-3038

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “EVERGREEN MEDICAL PRACTICE, P.C. ” Practice Location

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