1700853983 NPI number — CASCADE INTERNAL MEDICINE PS

Table of content: (NPI 1700853983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700853983 NPI number — CASCADE INTERNAL MEDICINE PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE INTERNAL MEDICINE PS
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:
JOHN DANIEL WANWIG MD
Provider Other Organization Name Type Code:
5
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:
1700853983
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:
1901 SO UNION
Provider Second Line Business Mailing Address:
ALLENMORE MEDICAL CENTER STE A305
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-272-3031
Provider Business Mailing Address Fax Number:
253-272-9449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 SO UNION
Provider Second Line Business Practice Location Address:
ALLENMORE MEDICAL CENTER STE A305
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-3031
Provider Business Practice Location Address Fax Number:
253-272-9449
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WANWIG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PHYSICIAN PRESIDENT
Authorized Official Telephone Number:
253-272-3031

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  12582 , 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: 1047786 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1300029 . This is a "MEDICAID MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21793 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8914379 . This is a "CRIME VICTIMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: WA7229 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".




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