Healthcare Provider Details

I. General information

NPI: 1669437497
Provider Name (Legal Business Name): CASCADE SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF ROAD, SUITE 100
BEND OR
97701
US

IV. Provider business mailing address

2200 NE NEFF ROAD, SUITE 100
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-8671
  • Fax: 541-322-2394
Mailing address:
  • Phone: 541-330-8671
  • Fax: 541-322-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number08-00002864
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: CAMMY GILSTRAP
Title or Position: CLINICAL DIRECTOR
Credential: CLINICAL DIRECTOR
Phone: 541-330-8671