Organization
EVERGREEN MEDICAL CENTER LLC
Active
Parent organization
EVERGREEN MEDICAL CENTER LLC
Other names
Nicole M Laird CRNP
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVERGREEN MEDICAL CENTER LLC
Authorized official
MRS. SHARON JONES (CHIEF FINANCIAL OFFICER)
(251) 578-2480
Entity
Organization
Contact information
Practice address
106 EDWINA ST, EVERGREEN, AL 36401-3319
(251) 578-4300
(251) 578-4307
Mailing address
106 EDWINA ST, EVERGREEN, AL 36401-3319
(251) 578-4300
(251) 578-4307
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19723
AL
207R00000X
Internal Medicine Physician
Primary
H1801
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510G700111
MEDICARE PTAN
AL
01
—
529906180
MEDICAID GROUP PAYEE NUMB
AL
01
—
529933018
MEDICAID PAYEE
AL
Enumeration date
05/22/2007
Last updated
04/20/2010
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