Provider Demographics
NPI:1215194774
Name:PUBLIC HOSPTIAL DISTRICT NO 2
Entity Type:Organization
Organization Name:PUBLIC HOSPTIAL DISTRICT NO 2
Other - Org Name:EVERGREEN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-2491
Mailing Address - Street 1:PO BOX 34603
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1603
Mailing Address - Country:US
Mailing Address - Phone:425-899-3270
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:MS-10
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-3270
Practice Address - Fax:425-899-3269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HOSPITAL DISTRICT NO 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty