Organization
EVERGREEN MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON JONES (CHIEF FINANCIAL OFFICER)
(251) 578-2480
Entity
Organization
Contact information
Practice address
101 CRESTVIEW AVE, EVERGREEN, AL 36401-3333
(251) 578-2480
(251) 578-1055
Mailing address
PO BOX 706, EVERGREEN, AL 36401-0706
(251) 578-2480
(251) 578-1055
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054
BCBS
AL
01
—
510G700322
MEDICARE PTAN
—
01
—
529933017
MEDICAID PHYSICIAN PAYEE
AL
05
—
H0S0148H
—
AL
01
—
H565
MEDICARE PHYSICIAN PAYEE
—
Enumeration date
12/07/2005
Last updated
09/09/2008
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