EVERGREEN MEDICAL CENTER PS (NPI# 1912953977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912953977 |
| Entity Type | Organization |
| Organization Name | EVERGREEN MEDICAL CENTER PS |
| Practice Address |
304 N Lieser Rd Vancouver WA 98664-2115 |
| Mailing Address |
Po Box 873175 Vancouver WA 98687-3175 |
| Practice Telephone | 3608968963 |
| Practice Fax Number | 3608969002 |
| Mailing Telephone | 3608968963 |
| Mailing Fax Number | 3608969002 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-08-30 |
| Authorized Official Name | FUHUA HOLLY GUO (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3608968963 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Street Address |
304 N LIESER RD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-2115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033115381 | Fuhua Holly Guo | Internal Medicine | 304 N Lieser Rd, Vancouver, WA 98664-2115 | 2005-06-22 |
| 1457670150 | Stacy Lee Beck | Registered Nurse | 304 N Lieser Rd, Vancouver, WA 98664-2115 | 2010-05-20 |
| 1801985254 | Nicholas F. Carulli Md, PC | Internal Medicine | 304 N Lieser Rd, Vancouver, WA 98664-2115 | 2006-10-12 |
| 1518056787 | Pidge Nechak | Physician Assistant | 304 N Lieser Rd, Vancouver, WA 98664-2115 | 2006-10-12 |
| 1871682237 | Nicholas F Carulli | Internal Medicine | 304 N Lieser Rd, Vancouver, WA 98664-2115 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
| Find all providers in zip 98664 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619215142 | Family Practice PC Huong Luu Md | Clinic/Center | 12004 Ne Fourth Plain Blvd Ste G, Vancouver, WA 98682-5564 | 2013-01-17 |
| 1538316658 | Safari Vision LLC | Clinic/Center | 720 Se 160th Ave Ste 103, Vancouver, WA 98684-8912 | 2008-08-20 |
| 1699284935 | Excel Naturopathic Wellness Pllc | Clinic/Center | 15640 Ne Fourth Plain Blvd Ste 120a, Vancouver, WA 98682 | 2017-09-28 |
| 1629454327 | Medilogic LLC | Clinic/Center | 406 Se 131st Ave, Suite 109, Vancouver, WA 98683-4004 | 2015-08-04 |
| 1164729398 | David T Lee Md Internal Medicine LLC | Clinic/Center | 406 Se 131st Ave, Suite 109, Vancouver, WA 98683-4004 | 2011-02-24 |
| 1497929152 | Vancouver Medical Weight Loss Clinic | Clinic/Center | 10000 Ne 7th Ave, Suite 110, Vancouver, WA 98685-4599 | 2008-04-14 |
| 1780751818 | Park Place Medical Center | Clinic/Center | 13115 Ne 4th St, Suite 230, Vancouver, WA 98684-5957 | 2006-11-30 |
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| 1922622158 | Vera Whole Health Wa, PC | Clinic/Center | 16009 E Indiana Ave, Spokane Valley, WA 99216 | 2020-06-03 |
| 1578183729 | Family Care Network Pllc | Clinic/Center | 3548 Meridian St, Suite #101-b, Bellingham, WA 98225 | 2020-04-17 |
| 1548800451 | Vera Whole Health Wa PC | Clinic/Center | 1601 N Division St, Spokane, WA 99207-2427 | 2020-01-08 |
| 1821634312 | Columbia Basin Mobile Medicine LLC | Clinic/Center | 1357 Platinum Pl, West Richland, WA 99353-5108 | 2019-11-20 |
| 1063056497 | A Community Wellness Clinic LLC | Clinic/Center | 2405 E 17th Ave Ste 113, Spokane, WA 99223-5122 | 2019-10-29 |
| 1013550987 | Rejuventa Medical Corp. | Clinic/Center | 107 North Tower Ave Suite 17, Centralia, WA 98531-4253 | 2019-10-23 |
| 1023668407 | Vera Whole Health Wa, PC | Clinic/Center | 4933 Evergreen Way, Everett, WA 98203-2828 | 2019-09-17 |
| 1679042501 | Family and Wellness Medicine | Clinic/Center | 34004 16th Ave S Ste 100, Federal Way, WA 98003-8905 | 2018-11-20 |
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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.