1659337889 NPI number — CASCADE SURGERY ASSOCIATES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659337889 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:
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:
1659337889
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:
253-288-2140
Provider Business Mailing Address Fax Number:
253-288-2219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 AUBURN AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-5082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-288-2140
Provider Business Practice Location Address Fax Number:
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: 261QA1903X , 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: 129453 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7096654 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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