1316957129 NPI number — CASCADE INTERNAL MEDICINE SPECIALISTS LLC

Table of content: MS. JENNIFER ANN MOSHER BCABA (NPI 1699295220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316957129 NPI number — CASCADE INTERNAL MEDICINE SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE INTERNAL MEDICINE SPECIALISTS LLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1316957129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2239 NE DOCTORS DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-7185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-318-0124
Provider Business Mailing Address Fax Number:
541-318-0188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2239 NE DOCTORS DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-7185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-318-0124
Provider Business Practice Location Address Fax Number:
541-318-0182
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROWDEN
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
541-318-0124

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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