Healthcare Provider Details

I. General information

NPI: 1922248749
Provider Name (Legal Business Name): CASCADE MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SE COLUMBIA WAY SUITE 190
VANCOUVER WA
98661-8056
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD SUITE 600
FRANKLIN TN
37067-2626
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-6461
  • Fax: 360-695-3064
Mailing address:
  • Phone: 800-445-9622
  • Fax: 615-771-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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