Evergreen Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EVERGREEN SURGERY CENTER, LLC

Practice address

12333 NE 130TH LN
Suite 500
Kirkland, WA 98034-7467

Phone

(425) 899-5656

Fax

(425) 899-5638

NPI assigned

Nov 9, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeff Tomlin, M.D.

Title

Executive Director

Phone

(425) 899-5656

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Surgical Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth D Faw, M.D.

  • Otolaryngology Physician
  • Kirkland, WA
  • NPI 1063429850
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1689655334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12333 NE 130TH LN",
            "address_2": "SUITE 500",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347467",
            "telephone_number": "425-899-5656",
            "fax_number": "425-899-5638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12333 NE 130TH LN",
            "address_2": "SUITE 500",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347467",
            "telephone_number": "425-899-5656",
            "fax_number": "425-899-5638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "TOMLIN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "425-899-5656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7123631",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evergreen in Home Mental Health
• Evergreen Medical Center Anesthesiology Services PS
• Evergreen Neurology Clinic, PLLC
• Evergreen Pediatrics PLLC
• Evergreen Radia LLC
• Evergreen Telepsychiatry PLLC
• Evergreen Urology Assoc Inc PS
• Evergreen Women'S Care, PLLC
• Evergreen Women'S Health Center PLLC
• Evergreen Womens Speciality Clinic

• All providers in Kirkland, WA
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.