| Evergreen Therapy Services-llc | |
|
1819 11th St Great Bend KS 67530-4511 | |
| (785) 483-9183 | |
| Not Available |
| Full Name | Evergreen Therapy Services-llc |
|---|---|
| Speciality | Social Worker |
| Location | 1819 11th St, Great Bend, Kansas |
| Authorized Official Name and Position | Pamela M Middleton (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7854839183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Therapy Services-llc 1819 11th St Great Bend KS 67530-4511 Ph: (785) 483-9183 | Evergreen Therapy Services-llc 1819 11th St Great Bend KS 67530-4511 Ph: (785) 483-9183 |
| NPI Number | 1720656135 |
|---|---|
| Provider Enumeration Date | 06/12/2021 |
| Last Update Date | 08/03/2021 |
| Certification Date | 08/03/2021 |
| Medicare PECOS PAC ID | 6901200955 |
|---|---|
| Medicare Enrollment ID | O20210812001845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720656135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Pamela M Middleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457702912 PECOS PAC ID: 1759712136 Enrollment ID: I20200519002633 |
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