Healthcare Provider Details

I. General information

NPI: 1194994145
Provider Name (Legal Business Name): CASCADE MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

PO BOX 6085
BEND OR
97708-6085
US

V. Phone/Fax

Practice location:
  • Phone: 541-598-3218
  • Fax: 541-383-4577
Mailing address:
  • Phone: 541-382-6633
  • Fax: 541-383-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STEPHEN SHULTZ
Title or Position: PARTNER
Credential: MD
Phone: 541-382-6633