Provider Demographics
NPI:1356695886
Name:EVERGREEN MEDICAL CENTER LLC
Entity type:Organization
Organization Name:EVERGREEN MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-578-0278
Mailing Address - Street 1:100 EDWINA STREET
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-3319
Mailing Address - Country:US
Mailing Address - Phone:251-578-0278
Mailing Address - Fax:251-578-0290
Practice Address - Street 1:100 EDWINA STREET
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3319
Practice Address - Country:US
Practice Address - Phone:251-578-0278
Practice Address - Fax:251-578-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty