EVERGREEN ENDOSCOPY CENTER, LLC (NPI# 1093974602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093974602 |
| Entity Type | Organization |
| Organization Name | EVERGREEN ENDOSCOPY CENTER, LLC |
| Practice Address |
2400 Tamarack Avenue Suite 100 South Windsor CT 06074 |
| Practice Telephone | 8606447336 |
| Mailing Telephone | 8606447336 |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2017-11-15 |
| Authorized Official Name | WILLIAM A WOLLMAN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8605332123 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QE0800X |
Clinic/Center Specialization: Endoscopy |
Ambulatory Health Care Facilities | ||
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | EVERGREEN ENDOSCOPY CENTER, LLC | 2400 Tamarack Avenue, Suite 100, South Windsor, CT 06074 |
| Street Address |
2400 TAMARACK AVENUE SUITE 100 |
| City | SOUTH WINDSOR |
| State | CT |
| Zip Code | 06074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164791547 | Acclaim Behavioral Services, LLC | Psychologist | 2400 Tamarack Avenue, South Windsor, CT 06074 | 2011-12-14 |
| 1427202720 | Janis Inesis Briga | Psychologist | 2400 Tamarack Avenue, Suite 201, South Windsor, CT 06074 | 2008-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174144919 | Russo Therapeutics, LLC | Occupational Therapist | 561 King Street, South Windsor, CT 06074 | 2020-05-04 |
| 1144706631 | Chana Judith Hoagland | Nurse Practitioner | 276 Quarry Brook Drive, South Windsor, CT 06074 | 2018-07-17 |
| 1093203291 | Climb Medical Group LLC | Counselor | 828 Sullivan Ave Ste A, South Windsor, CT 06074 | 2018-04-24 |
| 1528506516 | William P Guinan, Md and Associates LLC | Obstetrics & Gynecology | 25 Oakland Road, South Windsor, CT 06074 | 2017-02-09 |
| 1487027678 | Nadine Caron | Nurse Practitioner | 34 Pleasant Valley Rd, South Windsor, CT 06074 | 2015-11-10 |
| 1275957920 | Ellen Carol Ronsivalli | Dietitian, Registered | 70 High Street, South Windsor, CT 06074 | 2014-02-14 |
| 1881036457 | Chandra Yellinedi | Pharmacist | 55 Frazer Fir, South Windsor, CT 06074 | 2013-07-24 |
| 1144665969 | Brian Thomas Moy | Internal Medicine | 2400 Tamarack Ave Ste 101, South Windsor, CT 06074 | 2013-05-07 |
| 1093072886 | Lydia Lormand | Obstetrics & Gynecology | 2600 Tamarack Ave Ste 200, South Windsor, CT 06074 | 2012-04-18 |
| 1578847307 | International Institute for Professional Development, LLC | Social Worker | 435 Buckland Hills Road, South Windsor, CT 06074 | 2011-09-28 |
| Find all providers in zip 06074 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477017648 | Connecticut Orthopaedic Surgery Center, LLC | Clinic/Center | 205 Sub Way Drive, Milford, CT 06461 | 2019-01-22 |
| 1083188478 | Rocky Hill Surgery Center, LLC | Clinic/Center | 1111 Cromwell Ave Ste 100, Rocky Hill, CT 06067-3449 | 2019-01-18 |
| 1922576818 | Greater New Haven Asc, LLC | Clinic/Center | 2080 Whitney Ave Ste 100, Hamden, CT 06518-3603 | 2018-11-08 |
| 1396120168 | Stamford Asc LLC | Clinic/Center | 200 First Stamford Pl, Stamford, CT 06902-6753 | 2015-07-22 |
| 1821332370 | River Valley Asc LLC | Clinic/Center | 45 Salem Tpke, Norwich, CT 06360-6533 | 2012-11-22 |
| 1164732426 | Norwalk Surgery Center, LLC | Clinic/Center | 40 Cross St Ste 120, Norwalk, CT 06851-4698 | 2010-10-20 |
| 1326356320 | Orthopaedic & Neurosurgery Center of Greenwich, LLC | Clinic/Center | 55 Holly Hill Lane, Greenwich, CT 06830 | 2010-09-24 |
| 1053628883 | Plastic Surgery of So Ct | Clinic/Center | 208 Post Rd W, Westport, CT 06880-4604 | 2010-08-31 |
| 1932438553 | Middlesex Center for Advanced Orthopedic Surgery, LLC | Clinic/Center | 510 Saybrook Road, Middletown, CT 06457-4711 | 2009-12-10 |
| 1497904296 | International Cosmetic Surgery | Clinic/Center | 2 Mercia Ln, Greenwich, CT 06830-7068 | 2008-09-17 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH WINDSOR |
| Zip Code | 06074 |
Please comment or provide details below to improve the information on EVERGREEN ENDOSCOPY CENTER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.