NPI 1700074275

Evergreen Medical Panel

Organisation Health Maintenance Organization Tacoma, WA

Practice location

Address: 2411 S 19th St, Tacoma, WA 98405-2954
Phone: (253) 572-4171
Fax: (253) 572-4291

Authorised official

Name: Jessy E Ang
Title: Psychiaties
Phone: (253) 576-4171

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 0700013011 (WA)

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Registry record

NPI: 1700074275
Entity type: Organization
NPI issued: 10 Oct 2007
Record last updated: 11 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.