Organization
EVERGREEN FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY TYREE (COO)
(541) 229-3332
Entity
Organization
Contact information
Practice address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 229-3301
(541) 677-7462
Mailing address
2570 NW EDENBOWER BLVD, STE 100, ROSEBURG, OR 97470-6214
(541) 229-3301
(541) 677-7462
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000116
—
OR
01
—
CN5472
GROUP RAILROAD
OR
Enumeration date
02/07/2006
Last updated
07/22/2025
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