Healthcare Provider Details

I. General information

NPI: 1841366010
Provider Name (Legal Business Name): CASCADE ORTHOPEDICS & SPORTS MEDICINE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 E 12TH ST
THE DALLES OR
97058-3136
US

IV. Provider business mailing address

1715 E 12TH ST
THE DALLES OR
97058-3136
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-2294
  • Fax: 541-298-4123
Mailing address:
  • Phone: 541-296-2294
  • Fax: 541-298-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGROY M STANLEY
Title or Position: CORPORATE OFFICER
Credential: M.D.
Phone: 541-296-2294