Provider Demographics
NPI:1114102944
Name:CASCADE HEART CLINIC, PLLC
Entity Type:Organization
Organization Name:CASCADE HEART CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-454-1560
Mailing Address - Street 1:13033 BELLEVUE REDMOND RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2633
Mailing Address - Country:US
Mailing Address - Phone:425-454-1560
Mailing Address - Fax:425-457-7107
Practice Address - Street 1:13033 BELLEVUE REDMOND RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2633
Practice Address - Country:US
Practice Address - Phone:425-454-1560
Practice Address - Fax:425-457-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033528207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8207482Medicaid
WA8225278Medicaid
WAD93880Medicare UPIN
WA8207482Medicaid