Provider Demographics
NPI:1194483289
Name:EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC
Entity type:Organization
Organization Name:EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-729-0907
Mailing Address - Street 1:2008 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6934
Mailing Address - Country:US
Mailing Address - Phone:206-729-0907
Mailing Address - Fax:206-729-0199
Practice Address - Street 1:2008 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6934
Practice Address - Country:US
Practice Address - Phone:206-729-0907
Practice Address - Fax:206-729-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881741288OtherINDIVIDUAL NPI