Provider Demographics
NPI:1184885675
Name:EVERGREEN PEDIATRICS PLLC
Entity type:Organization
Organization Name:EVERGREEN PEDIATRICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-828-3626
Mailing Address - Street 1:433 STATE ST S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6615
Mailing Address - Country:US
Mailing Address - Phone:425-828-3626
Mailing Address - Fax:425-828-3628
Practice Address - Street 1:433 STATE ST S STE 1
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6615
Practice Address - Country:US
Practice Address - Phone:425-828-3626
Practice Address - Fax:425-828-3628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASMA RAEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-18
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care