Healthcare Provider Details

I. General information

NPI: 1235307265
Provider Name (Legal Business Name): CASCADE CENTER FOR PLASTIC & RECON SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE NEFF RD SUITE A
BEND OR
97701-6213
US

IV. Provider business mailing address

2100 NE NEFF RD SUITE A
BEND OR
97701-6213
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-3006
  • Fax: 541-382-7605
Mailing address:
  • Phone: 541-388-3006
  • Fax: 541-382-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD18444
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RICHARD EDWARD LINDSAY
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 541-480-1828