Provider Demographics
NPI:1952510265
Name:EVERGREEN WOMENS HEALTH CENTER
Entity Type:Organization
Organization Name:EVERGREEN WOMENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-687-6294
Mailing Address - Street 1:1998 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2349
Mailing Address - Country:US
Mailing Address - Phone:828-687-6294
Mailing Address - Fax:828-687-6277
Practice Address - Street 1:1998 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 31
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2349
Practice Address - Country:US
Practice Address - Phone:828-687-6294
Practice Address - Fax:828-687-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33034207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7931142Medicaid
NCC73333Medicare UPIN
NC7931142Medicaid