1639468432 NPI number — CASCADE WEST MEDICAL PRACTICE LLC

Table of content: MR. JOSE GABRIEL REINOSO MD (NPI 1215900659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639468432 NPI number — CASCADE WEST MEDICAL PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE WEST MEDICAL PRACTICE 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:
6
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:
1639468432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERLIN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97532-0738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-787-4360
Provider Business Mailing Address Fax Number:
360-216-7677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NE SAVAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-787-4360
Provider Business Practice Location Address Fax Number:
360-216-7677
Provider Enumeration Date:
04/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
541-450-8345

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  200850056NP , 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)





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