1669437497 NPI number — CASCADE SURGICENTER, LLC

Table of content: (NPI 1669437497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669437497 NPI number — CASCADE SURGICENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE SURGICENTER, 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:
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:
1669437497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 NE NEFF ROAD,
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-330-8671
Provider Business Mailing Address Fax Number:
541-322-2394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NE NEFF ROAD,
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-330-8671
Provider Business Practice Location Address Fax Number:
541-322-2394
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILSTRAP
Authorized Official First Name:
CAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
541-330-8671

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  08-00002864 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 197167600 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33601 . This is a "PACIFIC SOURCE HEALTH PLAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 269786 . This is a "OMAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38C0001068 . This is a "CCN (CMS CERTIFICATION NUMBER)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 610406200 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 338161 . This is a "PROVIDENCE HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 197475 . This is a "WA DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: P333601 . This is a "PACIFIC SOURCE" identifier . This identifiers is of the category "OTHER".




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