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General NPI Number Information
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NPI Number | 1376342469
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Entity Type | Organization
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Legal Business Name | CASCADE LAKES UROLOGY LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 431 NE REVERE AVE STE 200
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City | BEND
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State | OR
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Zip | 97701-4192
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Country | US
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Telephone | 541-508-7973
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Fax | 541-508-7968
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Provider Business Mailing Address
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Address Line | 431 NE REVERE AVE STE 200
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City | BEND
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State | OR
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Zip | 97701-4192
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Country | US
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Telephone | 541-508-7973
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Fax | 541-508-7968
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DENISE CHASE
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Credential |
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Telephone | 541-615-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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