1356307508 NPI number — CASCADE SURGERY ASSOCIATES

Table of content: (NPI 1356307508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356307508 NPI number — CASCADE SURGERY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE SURGERY ASSOCIATES
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:
1356307508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 3RD ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98002-4013
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:
27121 174TH PL SE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-638-8642
Provider Business Practice Location Address Fax Number:
253-638-8647
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
253-876-7030

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




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