Healthcare Provider Details

I. General information

NPI: 1922022425
Provider Name (Legal Business Name): CASCADE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE MANZANITA AVE
GRANTS PASS OR
97526-1431
US

IV. Provider business mailing address

120 NE MANZANITA AVE
GRANTS PASS OR
97526-1431
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-6636
  • Fax: 541-476-6690
Mailing address:
  • Phone: 541-479-2824
  • Fax: 541-474-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number395515
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier395515
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON MEDICAL LICENSE
# 2
Identifier399700000084893
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerDBID

VIII. Authorized Official

Name: DR. DOUGLAS R. MERRITT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-476-6636