Evergreen Family Medicine, Pc
LBN: Evergreen Family Medicine, Pc
Evergreen Family Medicine, Pc is an health care organization with primary practice located at 2570 Nw Edenbower Blvd Ste 100 , Roseburg OR 97471-6214. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Evergreen Family Medicine, Pc can be contacted via phone (541) 229-3301, or through Powell, Timothy J via phone (541) 229-3301.
Contact Information
Primary practice address
2570 Nw Edenbower Blvd Ste 100
Roseburg OR 97471-6214
Phone: (541) 229-3301
Fax: (541) 677-7462
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X |
Profile Details
| NPI number | 1417929050 |
|---|---|
| LBN Legal business name | Evergreen Family Medicine, Pc |
| DBA Doing business as | |
| Authorized official | Powell, Timothy J Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 7th, 2006 |
| Last updated | Dec 11th, 2009 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417929050 | NPPES |
| Oregon | MEDICAID | 000116 | |
| Oregon | Other | CN5472 |
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