THE EVERGREEN STATE COLLEGE (NPI# 1114195898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114195898 |
| Entity Type | Organization |
| Organization Name | THE EVERGREEN STATE COLLEGE |
| Practice Address |
2700 Evergreen Pkwy Nw Seminar 1 2110 Olympia WA 98505-0005 |
| Practice Telephone | 3608676808 |
| Practice Fax Number | 3608676787 |
| Mailing Telephone | 3608676808 |
| Mailing Fax Number | 3608676787 |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |
| Authorized Official Name | ELIZABETH MCHUGH (DIRECTOR OF COUNSELING & HEALTH SVC) |
| Authorized Official Telephone | 3608676808 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS1000X |
Clinic/Center Specialization: Student Health |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | THE EVERGREEN STATE COLLEGE FOUNDATION | 2700 Evergreen Pkwy Nw, #l3900, Olympia, WA 98505 |
| Street Address |
2700 EVERGREEN PKWY NW SEMINAR 1 2110 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98505-0005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770600629 | Rebecca Rae Johnson | Specialist/Technologist | 2700 Evergreen Pkwy Nw, Olympia, WA 98505-0001 | 2007-03-24 |
| 1104134923 | Susan Estelle Camp | Registered Nurse | 2700 Evergreen Pkwy Nw, Seminar 1-2110, Olympia, WA 98505-0001 | 2010-09-14 |
| 1144499682 | Kathleen Ann O'connor | Preventive Medicine | 2700 Evergreen Pkwy Nw, Sem I, 2110, Olympia, WA 98505-0005 | 2008-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841590502 | Barbara Ann Krulich | Physician Assistant | 2700 Evergreen Parkway Nw, Seminar I 2100, Olympia, WA 98505 | 2010-10-28 |
| 1447568563 | Polly Kay Taylor | Nurse Practitioner | 2700 Evergreen Parkway Nw, Sem 1, Room 2110, The Evergreen Sate College Student Health Center, Olympia, WA 98505 | 2010-09-23 |
| 1811370307 | Jared Vedros | Emergency Medicine | 786 D St, Anchorage, AK 98505 | 2015-07-02 |
| 1740246602 | Janine R Morrell | Nurse Practitioner | 315 Mlk Jr Way, Ms Z0 Ntl, Tacoma, WA 98505 | 2006-04-20 |
| 1609494830 | Madison Samantha Johnson | Counselor | The Evergreen State College 2700 Evergreen Parkway Nw, Olympia, WA 98505-0001 | 2020-07-14 |
| 1710504972 | Ryan Erickson | Counselor | 2700 Evergreen Pkwy Nw Bldg I2731, Olympia, WA 98505-0001 | 2020-07-02 |
| 1619285368 | Elizabeth R Mchugh | Physician Assistant | The Evergreen State College, Seminar 1 Rm 2110, Olympia, WA 98505-0001 | 2010-09-15 |
| 1770511438 | Mark S Peckler | Urology | 3525 Ensign Rd., Suite A, Olympia, WA 98505-0001 | 2006-06-29 |
| Taxonomy Code | 261QS1000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Student Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912242769 | Whitman Middle School | Clinic/Center | 9201 15th Ave Nw, Seattle, WA 98117-2336 | 2012-12-05 |
| 1114241478 | Pacific Lutheran University | Clinic/Center | 12108 S Park Ave, Tacoma, WA 98447-0001 | 2010-03-16 |
| 1720313026 | Student Health Options | Clinic/Center | 534 S 3rd Ave, Suite 16, Walla Walla, WA 99362-3177 | 2009-10-05 |
| 1114040755 | Childhaven - Gogerty Branch | Clinic/Center | 1345 22nd St Ne, Auburn, WA 98002-3442 | 2007-04-09 |
| 1457474090 | Childhaven - Lake City | Clinic/Center | 2350 Ne 95th St, Seattle, WA 98115-2433 | 2007-04-09 |
| 1245353887 | Childhaven - Creekmore Branch | Clinic/Center | 1035 Sw 124th St, Seattle, WA 98146-2746 | 2007-04-09 |
| 1770557290 | University of Puget Sound | Clinic/Center | 1500 N Warner St, Cmb 1035, Tacoma, WA 98416-5000 | 2006-02-13 |
| 1629048848 | Wwu Campus Health & Wellness | Clinic/Center | 133 S College Ave, Suite 101, College Place, WA 99324-1193 | 2006-01-23 |
| 1346464294 | Childhaven - Broadway Branch | Clinic/Center | 316 Broadway, Seattle, WA 98122-5325 | 2007-04-12 |
| 1326262452 | Western Washington University Student Health Center | Clinic/Center | 516 High St, Ms 9132, Bellingham, WA 98225-5946 | 2007-04-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.