| Evergreen Medical Group Duvall | |
|
14720 Main St Ne Ste 109 Duvall WA 98019-8460 | |
| (425) 788-4889 | |
| (425) 844-6116 |
| Full Name | Evergreen Medical Group Duvall |
|---|---|
| Speciality | Family Medicine |
| Location | 14720 Main St Ne, Duvall, Washington |
| Authorized Official Name and Position | Robert Malte (CEO) |
| Authorized Official Contact | 4258992610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Medical Group Duvall Po Box 34036 Seattle WA 98124-1036 Ph: (425) 899-3292 | Evergreen Medical Group Duvall 14720 Main St Ne Ste 109 Duvall WA 98019-8460 Ph: (425) 788-4889 |
| NPI Number | 1568563732 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 01/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568563732 | NPI | - | NPPES |
| CJ9678 | Other | WA | MEDICARE RAILROAD |
| CG2833 | Other | WA | MEDICARE RAILROAD |
| CQ2437 | Other | WA | MEDICARE RAILROAD |
| 7110562 | Medicaid | WA | |
| CG8137 | Other | WA | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Sno-valley Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15602 Main St Ne, 200, Duvall, WA 98019 Phone: 425-788-2490 Fax: 425-788-2462 |