Healthcare Provider Details

I. General information

NPI: 1215711023
Provider Name (Legal Business Name): CASCADE TRAUMA AND ACUTE CARE SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

PO BOX 5215
TACOMA WA
98415-0215
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-8327
  • Fax:
Mailing address:
  • Phone: 719-651-9443
  • Fax: 719-960-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDE YOUNGER
Title or Position: CFO
Credential:
Phone: 719-651-9443