Provider Demographics
NPI:1891754974
Name:EVERGREEN WOMENS HEALTH CARE PLLC
Entity Type:Organization
Organization Name:EVERGREEN WOMENS HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-882-0555
Mailing Address - Street 1:280 MAIN ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2919
Mailing Address - Country:US
Mailing Address - Phone:603-882-0555
Mailing Address - Fax:603-882-0360
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 131
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2919
Practice Address - Country:US
Practice Address - Phone:603-882-0555
Practice Address - Fax:603-882-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-19
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30D1022401OtherCLIA
MAM18351OtherBCBSMA
NH30212533Medicaid
MA696747OtherTUFTS HEALTH PLAN
NH3407428OtherAETNA HEALTHCARE
NH80031OtherHEALTHSOURCE
NH701468000OtherMAGELLAN BEHAVIORAL
NH=========OtherHCVM / FIRST HEALTH
NH=========OtherCIGNA HEALTHCARE
NH30212533Medicaid
MAM18351OtherBCBSMA
NH701468000OtherMAGELLAN BEHAVIORAL
NHDB4843Medicare ID - Type UnspecifiedRAILROAD MEDICARE