Evergreen Pediatric Clinic Ps

LBN: Evergreen Pediatric Clinic Ps
Evergreen Pediatric Clinic Ps is an health care organization with primary practice located at 505 Ne 87Th Ave Ste 120, Vancouver WA 98664-1989. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as the primary health care specialty. Evergreen Pediatric Clinic Ps can be contacted via phone (360) 892-1635, or through Bryant, Teri via phone (360) 892-1635.

Contact Information

Primary practice address
505 Ne 87Th Ave Ste 120 Vancouver WA 98664-1989
Phone: (360) 892-1635
Fax: (360) 892-3146
Website:
Map and Directions
Authorized official contact:
Name: Bryant, Teri
Phone: (360) 892-1635

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 601 115 723 Washington

Profile Details

NPI number 1144343773
LBN Legal business name Evergreen Pediatric Clinic Ps
DBA Doing business as
Authorized official Bryant, Teri
Entity Organization
Organization subpart 1 No
Enumeration date Apr 9th, 2007
Last updated Feb 21st, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144343773 NPPES
Washington MEDICAID 7033186

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