Provider Demographics
NPI:1801465273
Name:EVERGREEN NEUROSURGERY CENTER, PLLC
Entity type:Organization
Organization Name:EVERGREEN NEUROSURGERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-719-9681
Mailing Address - Street 1:PO BOX 130070
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0070
Mailing Address - Country:US
Mailing Address - Phone:281-719-9681
Mailing Address - Fax:877-805-3509
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 335
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2960
Practice Address - Country:US
Practice Address - Phone:281-719-9681
Practice Address - Fax:877-805-3509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN NEUROSURGERY CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty