EVERGREEN SURGERY CENTER LLC NPI 1538618368

NPI Information

NPI: 1538618368
Provider Name: EVERGREEN SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 05D2124212

Address:
2365 QUIMBY RD STE 180
SAN JOSE, CA
ZIP 95122
Phone: (408) 620-5675
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EVERGREEN SURGERY CENTER, LLC is an ambulatory surgical clinic center in San Jose, CA. EVERGREEN SURGERY CENTER, LLC NPI is 1538618368. The provider is registered as an organization entity type.

The provider's business location address is:

2365 QUIMBY RD STE 180
SAN JOSE, CA
ZIP 95122-337
Phone: (408) 620-5675
Fax: (408) 223-1534

The provider's authorized official is Hector Cervantes .
The authorized official title is Partner and has the following contact phone number (408) 620-5723.

The CLIA number assigned to this NPI record is 05D2124212 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/21/2016 and was last updated on 2/4/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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