Healthcare Provider Details

I. General information

NPI: 1578604591
Provider Name (Legal Business Name): CASCADE PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 NW LOVEJOY ST 505
PORTLAND OR
97210-3033
US

IV. Provider business mailing address

PO BOX 86309
PORTLAND OR
97286-0309
US

V. Phone/Fax

Practice location:
  • Phone: 503-226-4091
  • Fax:
Mailing address:
  • Phone: 503-242-9850
  • Fax: 503-226-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberMD20007
License Number StateOR

VIII. Authorized Official

Name: KENNY HEINE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 858-625-2990