Provider Demographics
NPI:1639226574
Name:EVERGREEN WOMEN'S CARE, PLLC
Entity Type:Organization
Organization Name:EVERGREEN WOMEN'S CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-250-1255
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE #420
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-6400
Mailing Address - Fax:425-899-4490
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE #420
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-6400
Practice Address - Fax:425-899-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126774Medicaid
WA8852772Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER