Organization
EVERGREEN FAMILY MEDICINE, PC
Active
Other names
Evergreen Family Medicine, Evergreen Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY TYREE (COO)
(541) 229-3332
Entity
Organization
Contact information
Practice address
1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 677-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213560
—
OR
01
—
610550200
GROUP OWCP
OR
01
—
845023000
GROUP BLUE CROSS
OR
01
—
J8799-01
GROUP PACIFIC SOURCE
OR
Enumeration date
02/07/2006
Last updated
03/24/2026
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