Healthcare Provider Details

I. General information

NPI: 1962752485
Provider Name (Legal Business Name): CASCADE MEDICAL TRANSPORT OF OREGON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 NE 15TH DRIVE
REDMOND OR
97756
US

IV. Provider business mailing address

P.O. BOX 5486
BEND OR
97708
US

V. Phone/Fax

Practice location:
  • Phone: 541-408-2855
  • Fax: 541-504-4516
Mailing address:
  • Phone: 503-508-7950
  • Fax: 541-504-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIXIE LYNN HANNON
Title or Position: OWNER
Credential:
Phone: 503-508-7950