Organization
EVERGREEN ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM A WOLLMAN (EXECUTIVE DIRECTOR)
(860) 533-2123
Entity
Organization
Contact information
Practice address
2400 TAMARACK AVENUE, SUITE 100, SOUTH WINDSOR, CT 06074
(860) 644-7336
Mailing address
2400 TAMARACK AVENUE, SUITE 100, SOUTH WINDSOR, CT 06074
(860) 644-7336
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QE0800X
Endoscopy Clinic/Center
—
—
Other
Enumeration date
06/09/2008
Last updated
11/15/2017
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