# EVERGREEN SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Surgical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689655334
- **Authorized official:** DR. JEFF TOMLIN M.D. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (425) 899-5656

## Contact information

- **Practice address:** 12333 NE 130TH LN, SUITE 500, KIRKLAND, WA 98034-7467
- **Practice address phone:** (425) 899-5656
- **Practice address fax:** (425) 899-5638
- **Mailing address:** 12333 NE 130TH LN, SUITE 500, KIRKLAND, WA 98034-7467
- **Mailing address phone:** (425) 899-5656
- **Mailing address fax:** (425) 899-5638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | WA | Yes |

## Other

- **Enumeration date:** 11/09/2005
- **Last updated:** 09/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7123631 | — | WA |