| Evergreen Testosterone Clinic & Primary Care | |
|
619 Matlock Centre Cir Arlington TX 76015-2535 | |
| (214) 870-0885 | |
| Not Available |
| Full Name | Evergreen Testosterone Clinic & Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 619 Matlock Centre Cir, Arlington, Texas |
| Authorized Official Name and Position | Ken Wamwiri (PRESIDENT AND CEO) |
| Authorized Official Contact | 2148700885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Testosterone Clinic & Primary Care 619 Matlock Centre Cir Arlington TX 76015-2535 Ph: (214) 870-0885 | Evergreen Testosterone Clinic & Primary Care 619 Matlock Centre Cir Arlington TX 76015-2535 Ph: (214) 870-0885 |
| NPI Number | 1942710256 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 10/02/2017 |
| Medicare PECOS PAC ID | 7012283682 |
|---|---|
| Medicare Enrollment ID | O20171026000400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942710256 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ken G Wamwiri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932550126 PECOS PAC ID: 4183945835 Enrollment ID: I20160808001499 |
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