Healthcare Provider Details

I. General information

NPI: 1144346420
Provider Name (Legal Business Name): CASCADE VASCULAR ASSOCIATES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S YAKIMA AVE STE 204A
TACOMA WA
98405
US

IV. Provider business mailing address

1802 S YAKIMA AVE STE 204A
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-3325
  • Fax: 253-572-7875
Mailing address:
  • Phone: 253-383-3325
  • Fax: 253-779-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: THERESE F LEWIS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 253-627-4650