| Evergreen Medical Group Kenmore | |
|
18208 66th Ave Ne Ste 200 Kenmore WA 98028-7949 | |
| (425) 485-6561 | |
| (425) 488-4939 |
| Full Name | Evergreen Medical Group Kenmore |
|---|---|
| Speciality | Family Medicine |
| Location | 18208 66th Ave Ne, Kenmore, 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 Kenmore Po Box 34036 Seattle WA 98124-1036 Ph: (425) 899-3292 | Evergreen Medical Group Kenmore 18208 66th Ave Ne Ste 200 Kenmore WA 98028-7949 Ph: (425) 485-6561 |
| NPI Number | 1629179890 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 01/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629179890 | NPI | - | NPPES |
| 7073323 | Medicaid | WA | |
| CQ2437 | Other | WA | MEDICARE RAILROAD |
| CJ9678 | Other | WA | MEDICARE RAILROAD |
| CG2833 | Other | WA | MEDICARE RAILROAD |
| CG8137 | Other | WA | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Rediclinic Of Wa, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 18022 68th Avenue Ne, Kenmore, WA 98028 Phone: 713-335-1754 |