Provider Demographics
NPI:1538390844
Name:EVERGREEN CLINIC PC
Entity type:Organization
Organization Name:EVERGREEN CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-756-7225
Mailing Address - Street 1:2181 HIGHWAY 2 EAST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2858
Mailing Address - Country:US
Mailing Address - Phone:406-756-7225
Mailing Address - Fax:406-756-5523
Practice Address - Street 1:2181 HIGHWAY 2 EAST
Practice Address - Street 2:SUITE 9
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2858
Practice Address - Country:US
Practice Address - Phone:406-756-7225
Practice Address - Fax:406-756-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center