EVERGREEN CHILDREN'S CLINIC, PLLC (NPI# 1568527539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1568527539 |
Entity Type | Organization |
Organization Name | EVERGREEN CHILDREN'S CLINIC, PLLC |
Other Organization Name | PEDIATRICS PM |
Practice Address |
1910 S Meridian Suite A Puyallup WA 98371-7531 |
Practice Telephone | 2538482303 |
Practice Fax Number | 2538488956 |
Mailing Telephone | 2538482303 |
Mailing Fax Number | 2538488956 |
Enumeration Date | 2006-12-27 |
Last Update Date | 2020-08-22 |
Authorized Official Name | MRS. SUSANNE I ROACH (OFFICE MANAGER) |
Authorized Official Telephone | 2538482303 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | 7054364 | 05 |
Other Name | Type Code |
---|---|
Pediatrics PM | Other Name - Individual/Organization |
Street Address |
1910 S MERIDIAN SUITE A |
City | PUYALLUP |
State | WA |
Zip Code | 98371-7531 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750303038 | Don R Russell | Pediatrics | 1910 S Meridian, Suite A, Puyallup, WA 98371-7531 | 2006-07-24 |
1588670798 | Susan E Ashton | Nurse Practitioner | 1910 S Meridian, Puyallup, WA 98371-7531 | 2006-07-31 |
1811901150 | Denise Anne Ladenburg | Nurse Practitioner | 1910 S Meridian, Puyallup, WA 98371-7531 | 2006-07-29 |
1528072865 | Mae Satsuki Yamasaki | Nurse Practitioner | 1910 S Meridian, Puyallup, WA 98371-7531 | 2006-07-29 |
1215941786 | William S Pollard IIi | Specialist | 1910 S Meridian, Puyallup, WA 98371-7531 | 2006-07-28 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588141550 | Karen Lynn Sorensen | Massage Therapist | 922 Valley Ave Nw Suite 101, Puyallup, WA 98371 | 2018-07-23 |
1487140257 | Bradley Dupea | Specialist/Technologist | 5702 44th St Se, Puyallup, WA 98371 | 2018-07-05 |
1740778695 | Pedraum Heydari | Dentist | 109 N Meridian Suite A, Puyallup, WA 98371 | 2018-04-26 |
1487030359 | Jennifer Block | Dental Hygienist | 601 4th Ave Sw, Puyallup, WA 98371 | 2015-08-03 |
1023423431 | On Your Own Inc. | Registered Nurse | 1602 Peach Park Ln Nw, Puyallup, WA 98371 | 2014-06-24 |
1841614997 | Enrique Somera | Registered Nurse | 1107 29th St Nw, Puyallup, WA 98371 | 2014-02-10 |
1033540893 | Ching Ju Chuang | Dentist | 1002 N. Meridian, Suite 104a, Puyallup, WA 98371 | 2013-12-04 |
1104161876 | Denise L. Vanaman | Registered Nurse | 214 W. Main, Puyallup, WA 98371 | 2012-12-06 |
1336491018 | Tacoma School District | Physical Therapy Assistant | 1721 8th Ave. S.w., Puyallup, WA 98371 | 2012-10-05 |
1275882052 | Robert Francis Saxton | Health Educator | 1121 W. Stewart, Puyallup, WA 98371 | 2012-09-07 |
Find all providers in zip 98371 |
Taxonomy Code | 2080A0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Adolescent Medicine |
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720498280 | Rainier Pediatrics, Inc | Pediatrics | 12904 94th Ave E, Puyallup, WA 98373-5538 | 2014-05-05 |
1497962831 | Puyallup Valley Pediatric Associates, P.s. | Pediatrics | 1322 3rd St Se, Suite #240, Puyallup, WA 98372-3771 | 2007-05-16 |
1841407285 | Puyallup Children's Clinic, Pllc | Pediatrics | 1322 3rd St Se, Ste #240, Puyallup, WA 98372-3771 | 2007-05-16 |
1710965538 | Holly N Johnson | Pediatrics | 1706 Meridian S, Suite 120, Puyallup, WA 98371-7516 | 2006-01-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568675544 | Robert Michael Lehman | Pediatrics | 1545 Nw 57th St, #522, Seattle, WA 98107-5643 | 2007-05-07 |
1134343676 | Michael Donlan | Pediatrics | 7103 N Skyline Dr, Spokane, WA 99208-6717 | 2007-04-13 |
1508927062 | David Alan Springer | Pediatrics | 4005 Wallingford Ave N, Seattle, WA 98103-8218 | 2006-12-12 |
1730247073 | Mohinder Singh Badyal | Pediatrics | 32124 1st Ave S, Ste100, Federal Way, WA 98003-5761 | 2006-12-05 |
1396813218 | Penny Russell Tronolone | Pediatrics | Echo Glen Children's Center, 33010 Se 99th St, Snoqualmie, WA 98065 | 2006-11-30 |
1164508792 | Deborah J Ayars | Pediatrics | 1901 S Union Ave Ste B1010, Tacoma, WA 98405-1801 | 2006-10-27 |
1922027168 | Tania Milad Matta | Pediatrics | 3950 Keene Road, West Richland, WA 99353 | 2006-07-19 |
1629025333 | Public Hospital District #1 of King County | Pediatrics | 6920 Coal Creek Pkwy Se, Ste 12, Newcastle, WA 98059-3147 | 2006-05-28 |
1861468720 | Gina Suzanne Sucato | Pediatrics | 13451 Se 36th St, Bellevue, WA 98006-1475 | 2006-02-28 |
1083605778 | Daryl William Linnell | Pediatrics | 784 14th Ave, Longview, WA 98632-2315 | 2005-11-02 |
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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.