Provider Demographics
NPI:1093988123
Name:EVERGREEN UROLOGY ASSOC INC PS
Entity Type:Organization
Organization Name:EVERGREEN UROLOGY ASSOC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:NOREHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-4646
Mailing Address - Street 1:12815 120TH AVE NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3003
Mailing Address - Country:US
Mailing Address - Phone:425-899-4646
Mailing Address - Fax:
Practice Address - Street 1:12815 120TH AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3003
Practice Address - Country:US
Practice Address - Phone:425-899-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty