EVERGREEN ENDOSCOPY CENTER, LLC; NPI #1093974602

Contact Information

EVERGREEN ENDOSCOPY CENTER, LLC

2400 TAMARACK AVENUE
SUITE 100
SOUTH WINDSOR, CT 06074

Phone: 860-644-7336
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Ambulatory Surgical	261QA1903X	49	Ambulatory Surgical Center
Endoscopy	261QE0800X

Indicates primary specialty

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NPI Profile & details for EVERGREEN ENDOSCOPY CENTER, LLC

NPI Number	`1093974602`
LBN Legal business name	EVERGREEN ENDOSCOPY CENTER, LLC
Authorized official	WILLIAM WOLLMAN - (EXECUTIVE DIRECTOR)
Entity	Organization
Organization subpart ¹	No
Enumeration date	06/09/2008
Last updated	11/15/2017 - About 9 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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