1124159819 NPI number — CASCADE OCCUPATIONAL MEDICINE PHYSICIANS INC

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 1124159819 NPI number — CASCADE OCCUPATIONAL MEDICINE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE OCCUPATIONAL MEDICINE PHYSICIANS INC
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:
1124159819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-0748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-635-1960
Provider Business Mailing Address Fax Number:
503-635-8354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 NE 48TH AVE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-726-1022
Provider Business Practice Location Address Fax Number:
503-726-1039
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRADDOCK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ROGERS
Authorized Official Title or Position:
CEO MEDICAL DIRECTOR
Authorized Official Telephone Number:
503-635-1960

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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