Basic Information
| Provider Information | |||||||||
| NPI: | 1255592218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERGREEN HEMATOLOGY AND ONCOLOGY PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E FARWELL ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 E FARWELL ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642873 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | YOLANDA | ||||||||
| AuthorizedOfficialFirstName: | JAEGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5094642873 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.