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EVERGREEN CLINIC LLC NPI 1689210551


NPI Information

NPI: 1689210551
Provider Name: EVERGREEN CLINIC LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 46D2267862

Address:
1561 W 7000 S STE 100
WEST JORDAN, UT
ZIP 84084
Phone: (801) 850-1958
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EVERGREEN CLINIC LLC is a family medicine in West Jordan, UT. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. EVERGREEN CLINIC LLC NPI is 1689210551. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1561 W 7000 S STE 100
WEST JORDAN, UT
ZIP 84084-556
Phone: (801) 850-1958
Fax: (801) 747-6881

The provider's authorized official is Ignacio Nicolas Gonzalez .
The authorized official title is Administrator and has the following contact phone number (801) 850-1958.

The CLIA number assigned to this NPI record is 46D2267862 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/25/2019 and was last updated on 1/13/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

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

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