Provider Demographics
NPI:1679623912
Name:EVERGREEN WOMENS SPECIALITY CLINIC
Entity type:Organization
Organization Name:EVERGREEN WOMENS SPECIALITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-821-2020
Mailing Address - Street 1:13030-121ST.WAY NE
Mailing Address - Street 2:202
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-821-2020
Mailing Address - Fax:425-823-8273
Practice Address - Street 1:13030-121ST. WAY NE
Practice Address - Street 2:202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3008
Practice Address - Country:US
Practice Address - Phone:425-821-2020
Practice Address - Fax:425-823-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty