Provider Demographics
NPI:1447319314
Name:EVERGREEN MEADOWS FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:EVERGREEN MEADOWS FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-674-3117
Mailing Address - Street 1:28000 MEADOW DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-674-3117
Mailing Address - Fax:303-674-5776
Practice Address - Street 1:28000 MEADOW DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-674-3117
Practice Address - Fax:303-674-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty