Healthcare Provider Details

I. General information

NPI: 1063141919
Provider Name (Legal Business Name): CASCADE ORTHOPEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PONDEROSA DR
SUTHERLIN OR
97479-9812
US

IV. Provider business mailing address

123 PONDEROSA DR
SUTHERLIN OR
97479-9812
US

V. Phone/Fax

Practice location:
  • Phone: 541-391-8155
  • Fax: 541-391-8154
Mailing address:
  • Phone: 541-391-8155
  • Fax: 541-391-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SARA MARKERT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 541-391-8155