EVERGREEN NEUROSURGERY CENTER, PLLC (NPI# 1285074047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285074047 |
| Entity Type | Organization |
| Organization Name | EVERGREEN NEUROSURGERY CENTER, PLLC |
| Practice Address |
111 Vision Park Blvd Ste 260 Shenandoah TX 77384 |
| Mailing Address |
Po Box 130070 Spring TX 77393-0070 |
| Practice Telephone | 2817199681 |
| Practice Fax Number | 2817910059 |
| Mailing Telephone | 2817199681 |
| Mailing Fax Number | 2817910059 |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2018-08-23 |
| Authorized Official Name | CYRIL T SEBASTIAN (OWNER) |
| Authorized Official Telephone | 2817199681 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | N6643 | TX | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | LICENSE | N6643 | 01 |
| Street Address |
111 VISION PARK BLVD STE 260 |
| City | SHENANDOAH |
| State | TX |
| Zip Code | 77384 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760494496 | Cyril T Sebastian | Neurological Surgery | 111 Vision Park Blvd Ste 260, Shenandoah, TX 77384 | 2006-08-12 |
| 1295383172 | Travis Lee Lockwood | Physician Assistant | 111 Vision Park Blvd Ste 260, Shenandoah, TX 77384-3004 | 2019-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104381441 | Reshanda Baudy | Registered Nurse | 2477 F.m. 1488 Rd, 536, Conroe, TX 77384 | 2019-01-31 |
| 1841768447 | Alina Nichole Smith | Physical Therapist | Texas Children's Hospital - The Woodlands, 17580 Interstate 45 South, The Woodlands, TX 77384 | 2018-11-13 |
| 1952878472 | Courtney Nicole Jersey | Physician Assistant | 17600 I-45 South, Conroe, TX 77384 | 2018-11-02 |
| 1558851394 | Woodlands Integrative Care Hospital | Psychiatric Hospital | 1006 Windsor Lake Blvd., Suite 200, Conroe, TX 77384 | 2018-05-17 |
| 1326570334 | Surgeons Assistant Rita Yamel David Inc | Specialist/Technologist, Other | 3720 College Park Dr # 6304, Conroe, TX 77384 | 2017-03-29 |
| 1316483191 | Jason Cazares | Specialist/Technologist | 17450 St. Luke's Way, Medical Arts Center IIi, #350, The Woodlands, TX 77384 | 2017-01-17 |
| 1023564325 | 1488 Family Medicine Group, Pllc | Clinic/Center | 2400 Fm 1488, Suite 400, Conroe, TX 77384 | 2016-08-28 |
| 1740641976 | Signature Smiles Woodlands, Pllc | Clinic/Center | 2400 Fm 1488 Suite 200, Conroe, TX 77384 | 2016-03-16 |
| 1427397256 | David William White | Dentist | 3600 Farm To Market Rd 1488 #90, Conroe, TX 77384 | 2013-02-14 |
| 1740549542 | North Woods Family Medicine Pllc | Family Medicine | 17350 St.luke's Way, Suite 350, The Woodlands, TX 77384 | 2012-05-14 |
| Find all providers in zip 77384 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134254741 | Women's Healthcare Affiliates, P. A. | Specialist | 9180 Pinecroft Drive, Ste 100, Shenandoah, TX 77380 | 2007-02-22 |
| 1023001617 | Adolph Michael Wychulis | Specialist | 24 S Main St, Shenandoah, PA 17976-2331 | 2005-08-29 |
| 1932107067 | Marco A Giannotti | Specialist | 9180 Pinecroft Dr Ste 100, Shenandoah, TX 77380 | 2005-07-12 |
| 1477551059 | Khoa Trong Nguyen | Specialist | 920 Medical Plaza Dr, Suite 380, Shenandoah, TX 77380-3260 | 2005-07-08 |
| 1548418338 | Specialists for Women | Specialist | 9200 Pinecroft Dr, 350, Shenandoah, TX 77380-3279 | 2008-09-04 |
| 1255515235 | A. G. Moore M.d, P.a. | Specialist | 1120 Medical Plaza Dr, Suite 340, Shenandoah, TX 77380-3242 | 2007-12-26 |
| 1164604104 | Michelle A Hanes Mdpa | Specialist | 1120 Medical Plaza Dr, Suite 150, Shenandoah, TX 77380-3242 | 2007-12-01 |
| 1255513297 | Michelle M. Mulder, M.d.p.a. | Specialist | 1120 Medical Plaza Dr, Suite #150, Shenandoah, TX 77380-3242 | 2007-12-01 |
| 1326228115 | Blake A. Berryhill | Specialist | 9180 Pinecroft Dr Ste 100, Shenandoah, TX 77380-3880 | 2007-11-08 |
| 1326163916 | Womens Centre for Well Being Pa | Specialist | 1120 Medical Plaza Dr, 200, Shenandoah, TX 77380-3242 | 2007-03-20 |
| Find all providers in SHENANDOAH | ||||
| City | SHENANDOAH |
| Zip Code | 77384 |
Please comment or provide details below to improve the information on EVERGREEN NEUROSURGERY CENTER, PLLC.
| 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.