EVERGREEN AESTHETIC INSTITUTE LLC (NPI# 1710073176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710073176 |
| Entity Type | Organization |
| Organization Name | EVERGREEN AESTHETIC INSTITUTE LLC |
| Other Organization Name | EAI |
| Practice Address |
1104 W Evergreen Ave Suite B Effingham IL 62401-1710 |
| Practice Telephone | 2173427090 |
| Practice Fax Number | 2173427094 |
| Mailing Telephone | 2173427090 |
| Mailing Fax Number | 2173427094 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. THEODORE FIFER (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2173427090 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA0006X |
Clinic/Center Specialization: Ambulatory Fertility Facility |
2198 | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| EAI | Doing Business As Name - Organization |
| Street Address |
1104 W EVERGREEN AVE SUITE B |
| City | EFFINGHAM |
| State | IL |
| Zip Code | 62401-1710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922018332 | James J Flaig | Surgery | 1104 W Evergreen Ave, Effingham, IL 62401-1710 | 2006-08-08 |
| 1083711287 | The Fifer Center for Plastic Surgery Ltd | Plastic Surgery | 1104 W Evergreen Ave, Effingham, IL 62401-1710 | 2006-09-20 |
| 1154331411 | Kevin D Malone | Surgery | 1104 W Evergreen Ave, Effingham, IL 62401-1710 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568021269 | Rhodes To Health, LLC | Chiropractor | 200 E. Fayette Ave, Effingham, IL 62401 | 2019-06-07 |
| 1467951699 | Sarah Bush Lincoln Health Center | Durable Medical Equipment & Medical Supplies | 903 N Maple St, Effingham, IL 62401 | 2018-02-02 |
| 1033632187 | Diel Counseling Inc. | Counselor | 444 S. Willow #7, Effingham, IL 62401 | 2017-07-20 |
| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
| 1194107102 | Radhika Annam | Internal Medicine | 500 N. Maple St., Joslin Diabetes Center Affiliate At Hshs Medical Group, Effingham, IL 62401 | 2015-06-25 |
| 1912334558 | Ruben Boyajian, Md | Surgery | 904 Medical Park Drive, Suite 2, Effingham, IL 62401 | 2013-09-27 |
| 1427483502 | Daniel E Czajkowski | Physical Therapist | 2611 S Banker St, Effingham, Il, Effingham, IL 62401 | 2013-09-09 |
| 1093140501 | Lifetime Dental Care of Maryland, Badger, P.C. | Dentist | 1200 Network Centre Drive, Suite #2, Effingham, IL 62401 | 2013-09-04 |
| 1689926487 | Wellness Loft Inc. | Counselor | 408 South 4th St., Effingham, IL 62401 | 2012-10-04 |
| 1598011470 | Patricia R. Diel | Social Worker | 444 S. Willow, Suite 7, Effingham, IL 62401 | 2012-07-30 |
| Find all providers in zip 62401 | ||||
| Taxonomy Code | 261QA0006X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Fertility Facility |
| A fertility facility, which may be licensed, registered, or certified in some states, that is not hospital-based, where services are provided at a fixed specific location. An Ambulatory Fertility Facility does not provide overnight accommodations. The following fertility procedures may be performed at an Ambulatory Fertility Facility: In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Embryo Transfer-Thaw (ET-T), Zygote Intrafallopian Transfer (ZIFT), Donor OOCYTE (DO) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043348477 | Oak Brook Fertility Center, Ltd. | Clinic/Center | 2425 W 22nd St, Ste. 102, Oak Brook, IL 60523-1245 | 2007-02-28 |
| 1275542169 | Robert Stephen Kubert | Clinic/Center | 411 Martin Luther King Dr, Peoria, IL 61604 | 2006-08-07 |
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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.