Evergreen Aesthetic Institute LLC

Primary specialty

Ambulatory Fertility FacilityTaxonomy code 261QA0006X

License

2198 Issued in IL

Legal business name

EVERGREEN AESTHETIC INSTITUTE LLC

Practice address

1104 W Evergreen Ave
Suite B
Effingham, IL 62401-1710

Phone

(217) 342-7090

Fax

(217) 342-7094

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Theodore Fifer, MD

Title

Medical Director

Phone

(217) 342-7090

Specialties & licenses 1

Addresses

Other names 1

• EAI Doing business as

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710073176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 W EVERGREEN AVE",
            "address_2": "SUITE B",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624011710",
            "telephone_number": "217-342-7090",
            "fax_number": "217-342-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 W EVERGREEN AVE",
            "address_2": "SUITE B",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624011710",
            "telephone_number": "217-342-7090",
            "fax_number": "217-342-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AESTHETIC INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FIFER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "217-342-7090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA0006X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Fertility Facility",
            "state": "IL",
            "license": "2198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valerie Engelbart, BS
• Esa SC
• Bridget Katherine Estes, CRNA
• Candi Jo Estes, FNP-BC
• Erin Evans, PHARMD
• Evergreen Nursing and Rehab Center
• Jeemin Eversole, NP
• Faith Griffin Grifin Therapeutic Solutions
• Family Care Associates of Effingham, S.C.
• Cari A. Fearday, PA-C

• Ambulatory Fertility Facility in Effingham, IL
• Providers in Effingham, IL by specialty
• Ambulatory Fertility Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.