1558327601 NPI number — CASCADE SURGERY ASSOCIATES, PLLC

Table of content: (NPI 1558327601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558327601 NPI number — CASCADE SURGERY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE SURGERY ASSOCIATES, PLLC
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:
CASCADE ORTHOPAEDICS
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:
1558327601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35142 #698909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-5142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-833-7750
Provider Business Mailing Address Fax Number:
253-833-7469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21525 SR 410 E
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-4190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-862-2920
Provider Business Practice Location Address Fax Number:
253-862-5186
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULLER
Authorized Official First Name:
SHAUN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
253-833-7750

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7066277 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75850 . This is a "L&I GRP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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