Healthcare Provider Details

I. General information

NPI: 1639160229
Provider Name (Legal Business Name): CASCADE MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14727 NE 87TH ST
REDMOND WA
98052-6500
US

IV. Provider business mailing address

PO BOX 681646
FRANKLIN TN
37068-1646
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-0504
  • Fax: 866-433-3306
Mailing address:
  • Phone: 615-771-8839
  • Fax: 615-550-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number602 158 743
License Number StateWA

VIII. Authorized Official

Name: THEODORE M HIRSCH
Title or Position: VP OF OPERATIONS
Credential:
Phone: 800-445-9622