1447202668 NPI number — CASCADE CARDIOLOGY LLC

Table of content: (NPI 1447202668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447202668 NPI number — CASCADE CARDIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE CARDIOLOGY 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:
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:
1447202668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 COMMERCIAL ST SE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-3421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-485-4787
Provider Business Mailing Address Fax Number:
503-485-4789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 COMMERCIAL ST SE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-485-4787
Provider Business Practice Location Address Fax Number:
503-485-4789
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WIGSTROM
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
CREDENTIALING AND CONTRACTING SPECI
Authorized Official Telephone Number:
503-485-4787

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276218 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB8768 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 82569100 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".