# EVERGREEN FAMILY MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417929050
- **Authorized official:** KIMBERLY TYREE (COO)
- **Authorized official phone:** (541) 229-3332

## Contact information

- **Practice address:** 2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
- **Practice address phone:** (541) 229-3301
- **Practice address fax:** (541) 677-7462
- **Mailing address:** 2570 NW EDENBOWER BLVD, STE 100, ROSEBURG, OR 97470-6214
- **Mailing address phone:** (541) 229-3301
- **Mailing address fax:** (541) 677-7462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2006
- **Last updated:** 07/22/2025