OrganizationActive
Evergreen Aesthetic Institute LLC
NPI 1710073176 · Ambulatory Fertility Facility · Effingham, IL
Provider details
- NPI number
- 1710073176
- Entity type
- Organization
- Primary specialty
- Ambulatory Fertility FacilityAmbulatory Health Care Facilities
- Authorized official
- Theodore Fifer, Medical Director
- License
- 2198 (IL)
Practice location
1104 W Evergreen Ave
Suite B
Effingham, IL 62401-1710
Phone: (217) 342-7090
Fax: (217) 342-7094
Mailing address
1104 W Evergreen Ave
Effingham, IL 62401-1710
Registry dates
- Enumerated
- 2006-10-05
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.