1477616936 NPI number — CASCADE HERNIA AND SURGICAL SOLUTIONS PS

Table of content: (NPI 1477616936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477616936 NPI number — CASCADE HERNIA AND SURGICAL SOLUTIONS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE HERNIA AND SURGICAL SOLUTIONS PS
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:
MERIDIAN SURGICAL SERVICES
Provider Other Organization Name Type Code:
3
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:
1477616936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 17TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-840-1999
Provider Business Mailing Address Fax Number:
253-445-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 17TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-840-1999
Provider Business Practice Location Address Fax Number:
253-445-4125
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-840-1999

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  FX00057051 , 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: 5353ME . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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