1346228699 NPI number — CASCADE PROSTHETICS AND ORTHOTICS INC

Table of content: (NPI 1346228699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346228699 NPI number — CASCADE PROSTHETICS AND ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE PROSTHETICS AND ORTHOTICS INC
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:
1346228699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 SUNSET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98248-8913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-384-1858
Provider Business Mailing Address Fax Number:
360-384-1927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98248-8913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-384-1858
Provider Business Practice Location Address Fax Number:
360-384-1927
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEYMER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
360-384-1858

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  600446461 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 600446461 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90032681 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO576WA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00630201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002111404 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440415 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6738087 . This is a "BSHCN 1ST STEPS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CAJ52110 . This is a "CSHCN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 003256500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090765100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0510029 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0986836 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100027950A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 527806 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 98001894 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701450 . This is a "HSCSN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1934071 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 844600800 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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