1467635193 NPI number — CASCADE SURGICCAL ONCOLOGY, PC

Table of content: (NPI 1467635193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467635193 NPI number — CASCADE SURGICCAL ONCOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE SURGICCAL ONCOLOGY, PC
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:
1467635193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 HILYARD ST STE S550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-8152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-302-6469
Provider Business Mailing Address Fax Number:
541-302-6473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 HILYARD ST STE S550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-8152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-302-6469
Provider Business Practice Location Address Fax Number:
541-302-6473
Provider Enumeration Date:
12/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TREZONA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-302-6469

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5659440001 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 801750000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 240426 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".