EVERGREEN DERMATOPATHOLOGY LLC – NPI #1174187165
Dermatology

A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

EVERGREEN DERMATOPATHOLOGY LLC is a dermatologist located in COEUR D'ALENE, ID. NPPES has assigned the NPI number 1174187165 to EVERGREEN DERMATOPATHOLOGY LLC on April 25, 2019. 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 207ND0900X from the Health Care Provider Taxonomy code set, which is classified as Dermatology, specializing in Dermatopathology

The NPI profile was previously updated about 7 years ago on Sep 06, 2019. 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 DERMATOPATHOLOGY LLC below.

NPI Profile for
EVERGREEN DERMATOPATHOLOGY LLC

NPI Number
1174187165
Enumeration Date

(more than 7 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 DERMATOPATHOLOGY LLC
Primary location
421 E LAKESIDE AVE STE 105
COEUR D'ALENE, ID 83814-2848
Phone: (208) 277-9704 Fax: (208) 277-9704
Mailing address
2151 N MAIN ST STE 248
COEUR D ALENE, ID 83814-5773
Phone: (843) 822-5550 Fax:
Organization Subpart
No
Authorized Official
ASHLEY HAMSTRA
OWNER
Phone: (208) 277-9704
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
207ND0900X
- Dermatology / Dermatopathology (Primary)
207N00000X
- Dermatology

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.