Provider Demographics
NPI:1457808933
Name:EVERGREEN FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:EVERGREEN FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-244-5879
Mailing Address - Street 1:6928 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-462-9339
Mailing Address - Fax:571-565-3144
Practice Address - Street 1:6928 LITTLE RIVER TURNPIKE
Practice Address - Street 2:SUITE B
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-462-9339
Practice Address - Fax:571-565-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty