1154465656 NPI number — CASCADE PATHOLOGY SERVICES, CORP

Table of content: (NPI 1154465656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154465656 NPI number — CASCADE PATHOLOGY SERVICES, CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE PATHOLOGY SERVICES, CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154465656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-4207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-268-4850
Provider Business Mailing Address Fax Number:
503-268-4801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 NE 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-5049
Provider Business Practice Location Address Fax Number:
503-413-5054
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRATTENDICK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
561-514-5822

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 037486 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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