Active NPI
Evergreen Neurology & Neurodiagnostic PLLC
- Neuromusculoskeletal Medicine & OMM Physician
- Everett, WA
National Provider Identifier
1851572564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician
- License
- MD00032822
- Legal business name
- EVERGREEN NEUROLOGY & NEURODIAGNOSTIC PLLC
- Practice address
- 2326 Rucker Ave
Everett, WA 98201-2723 - Phone
- (425) 259-5121
- Fax
- (425) 252-2189
- NPI assigned
- Nov 21, 2007
- Organization subpart
- Yes
- Parent organization
- ROMAN L KUTSY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Charis J Yates
- Title
- Billing
- Phone
- (425) 259-5121
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | MD00032822 | WA | Primary |
Addresses
Primary practice location
2326 Rucker Ave
Everett, WA 98201-2723
Mailing address
2320 Rucker Ave
Everett, WA 98201-2723
Phone (425) 259-5121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1118462 | Medicaid | WA |
National Provider Directory
National Provider Directory- Part of
- Evergreen Neurology Neuro
Locations
2326 Rucker Ave
Everett, WA 98201
Phone (425) 259-5121
2320 Rucker Ave
Everett, WA 98201
Phone (425) 259-5121
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195603200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1195603200000",
"number": "1851572564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2320 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982012723",
"telephone_number": "425-259-5121",
"fax_number": "425-252-2189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2326 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982012723",
"telephone_number": "425-259-5121",
"fax_number": "425-252-2189"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN NEUROLOGY & NEURODIAGNOSTIC PLLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ROMAN L KUTSY",
"enumeration_date": "2007-11-21",
"last_updated": "2007-11-21",
"status": "A",
"authorized_official_last_name": "YATES",
"authorized_official_first_name": "CHARIS",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "BILLING",
"authorized_official_telephone_number": "425-259-5121",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "204D00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "WA",
"license": "MD00032822",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1118462",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
- Everett Urological, PLLC. (Everett Urology)
- Everett Vision Therapy
- James Dwight Everett, MA, LMHC
- Evergreen Dental Corporation
- Evergreen Home Health & Hospice Care, LLC
- Evergreen Park Professionals
- Evergreen Recovery Centers
- Evergreen Recovery Centers
- Evergreen Recovery Centers
- Evergreen Ridge Care,LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.