EVERGREEN SURGERY CENTER, LLC (NPI# 1689655334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689655334 |
| Entity Type | Organization |
| Organization Name | EVERGREEN SURGERY CENTER, LLC |
| Other Organization Name | EVERGREEN SURGICAL CENTER |
| Practice Address |
12333 Ne 130th Ln Suite 500 Kirkland WA 98034-7467 |
| Practice Telephone | 4258995656 |
| Practice Fax Number | 4258995638 |
| Mailing Telephone | 4258995656 |
| Mailing Fax Number | 4258995638 |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-09-20 |
| Authorized Official Name | DR. JEFF TOMLIN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4258995656 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7123631 | 05 |
| Other Name | Type Code |
|---|---|
| Evergreen Surgical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538618368 | Evergreen Surgery Center, LLC | Clinic/Center | 2365 Quimby Rd Ste 180, San Jose, CA 95122-1337 | 2016-09-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN SURGERY CENTER, LLC | 12040 Ne 128th St, Attn: Kcphd#2 D/b/a Evergreenhealth, Kirkland, WA 98034-3013 |
| Street Address |
12333 NE 130TH LN SUITE 500 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034-7467 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538169768 | Steven Michael Dawson | Specialist | 12333 Ne 130th Ln, Suite 440, Kirkland, WA 98034-7467 | 2005-07-29 |
| 1003364258 | Kirsten Myhres | Genetic Counselor, MS | 12333 Ne 130th Ln, Tan 240, Kirkland, WA 98034-7467 | 2016-09-16 |
| 1043694185 | King County Public Hospital District No. 2 | Clinic/Center | 12333 Ne 130th Ln, #420, Kirkland, WA 98034-7467 | 2015-07-18 |
| 1285028837 | Rebecca Lewis | Physician Assistant | 12333 Ne 130th Ln, Suite 400, Kirkland, WA 98034-7467 | 2015-03-21 |
| 1427440296 | Marlene Woolf | Pharmacist | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-03-03 |
| 1588054332 | Evergreenhealthcare | Clinic/Center | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-02-02 |
| 1801286810 | Katelin Toshiko Brooks | Pharmacist | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-01-28 |
| 1770983108 | Margo Hollenbeck | Pharmacist | 12333 Ne 130th Ln, Kirkland, WA 98034-7467 | 2014-09-04 |
| 1528304292 | Proliance Surgeons, Inc., P.s. | Otolaryngology | 12333 Ne 130th Ln, Suite 440, Kirkland, WA 98034-7467 | 2012-12-27 |
| 1245590637 | Julianna Nadine Walker | Genetic Counselor, MS | 12333 Ne 130th Ln, Suite Tan 240, Kirkland, WA 98034-7467 | 2012-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235419334 | Partington Plastic Surgery Center | Clinic/Center | 10220 Ne Points Dr Ste 110, Kirkland, WA 98033-7864 | 2011-08-19 |
| 1417118472 | David F. Pratt Md Ps | Clinic/Center | 10413 Ne 37th Cir, Bldg 3, Ste B, Kirkland, WA 98033-7924 | 2008-06-23 |
| 1043694185 | King County Public Hospital District No. 2 | Clinic/Center | 12333 Ne 130th Ln, #420, Kirkland, WA 98034-7467 | 2015-07-18 |
| 1225305477 | Puget Sound Plastic Surgery | Clinic/Center | 16 Central Way, Suite A, Kirkland, WA 98033-6115 | 2011-11-16 |
| 1215249941 | Yarrow Bay Plastic Surgery Center | Clinic/Center | 5209 Lake Washington Blvd Ne, Suite 115, Kirkland, WA 98033-7355 | 2010-07-10 |
| 1942417969 | Northwest Nasal Sinus Center | Clinic/Center | 3100 Carillon Pt, Kirkland, WA 98033-7306 | 2007-05-17 |
| 1750401147 | Northwest Nasal Sinus Asc | Clinic/Center | 3100 Carillon Pt, Kirkland, WA 98033-7306 | 2007-03-30 |
| 1952310211 | Washington Institute Orthopedic Center | Clinic/Center | 12707 120th Ave Ne, Suite 205, Kirkland, WA 98034-7500 | 2006-08-05 |
| 1871512756 | Eastside Urology Associates,. P.s. | Clinic/Center | 11911 Ne 132nd St, Suite 200, Kirkland, WA 98034-2900 | 2006-07-19 |
| 1952340036 | Proliance Surgeons, Inc., P.s. | Clinic/Center | 12333 Ne 130th Ln, Suite 420, Kirkland, WA 98034-7467 | 2006-06-05 |
| Find all providers in KIRKLAND | ||||
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| 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.