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General NPI Number Information
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NPI Number | 1801891668
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Entity Type | Organization
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Legal Business Name | CASCADE SPINE CENTER, LLC
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 6464 SW BORLAND RD BLDG A STE A-3
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City | TUALATIN
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State | OR
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Zip | 97062-8876
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Country | US
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Telephone | 971-404-3366
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Fax | 971-404-3377
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Provider Business Mailing Address
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Address Line | 6464 SW BORLAND RD BLDG A STE A-3
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City | TUALATIN
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State | OR
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Zip | 97062-8876
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Country | US
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Telephone | 971-404-3366
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Fax | 971-404-3377
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Authorized Official
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Title or Position | OFFIICER/AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 071546
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License Number State | OR
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