Healthcare Provider Details

I. General information

NPI: 1013071877
Provider Name (Legal Business Name): CASCADE IMAGING ASSOCIATES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-4111
  • Fax:
Mailing address:
  • Phone: 360-424-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number602444293
License Number StateWA

VIII. Authorized Official

Name: THOMAS C. LITTAKER
Title or Position: CFO
Credential:
Phone: 360-424-2505