| Evergreen Health Center Llc | |
|
520 Route 8 Maite GU 96910 | |
| (671) 922-0118 | |
| (671) 477-2464 |
| Full Name | Evergreen Health Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 520 Route 8, Maite, Guam |
| Authorized Official Name and Position | Jayar Calilung (CLINIC MANAGER) |
| Authorized Official Contact | 6714888817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Health Center Llc 520 Route 8 Maite GU 96910 Ph: (671) 922-0118 | Evergreen Health Center Llc 520 Route 8 Maite GU 96910 Ph: (671) 922-0118 |
| NPI Number | 1356839575 |
|---|---|
| Provider Enumeration Date | 04/23/2018 |
| Last Update Date | 03/29/2020 |
| Medicare PECOS PAC ID | 4082958822 |
|---|---|
| Medicare Enrollment ID | O20181204003460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356839575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Delores J Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760826937 PECOS PAC ID: 3971882846 Enrollment ID: I20161116002394 |
| Provider Name | Frank J Farrell |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1891770905 PECOS PAC ID: 6406953710 Enrollment ID: I20190111001493 |
| Provider Name | Faraz Ouhadi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063517639 PECOS PAC ID: 2466449855 Enrollment ID: I20200901002734 |