EVERGREEN ENDOSCOPY CENTER, LLC – NPI #1093974602
Clinic/Center

EVERGREEN ENDOSCOPY CENTER, LLC is an AHC clinic located in SOUTH WINDSOR, CT. NPPES has assigned the NPI number 1093974602 to EVERGREEN ENDOSCOPY CENTER, LLC on June 09, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was previously updated about 9 years ago on Nov 15, 2017. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EVERGREEN ENDOSCOPY CENTER, LLC below.

NPI Profile for
EVERGREEN ENDOSCOPY CENTER, LLC

NPI Number
1093974602
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EVERGREEN ENDOSCOPY CENTER, LLC
Primary location
2400 TAMARACK AVENUE
SUITE 100
SOUTH WINDSOR, CT 06074
Phone: (860) 644-7336 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
WILLIAM WOLLMAN
EXECUTIVE DIRECTOR
Phone: (860) 533-2123
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)
261QE0800X
- Clinic/Center / Endoscopy

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.