Provider Demographics
NPI:1144346420
Name:CASCADE VASCULAR ASSOCIATES PS
Entity type:Organization
Organization Name:CASCADE VASCULAR ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-627-4650
Mailing Address - Street 1:1802 S YAKIMA AVE
Mailing Address - Street 2:STE 204A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-3325
Mailing Address - Fax:253-779-0796
Practice Address - Street 1:1802 S YAKIMA AVE
Practice Address - Street 2:STE 204A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-383-3325
Practice Address - Fax:253-572-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7043979Medicaid
WA7043979Medicaid