Provider Demographics
NPI:1114395167
Name:CASCADE MEDICAL SPECIALTIES, LLC
Entity Type:Organization
Organization Name:CASCADE MEDICAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-305-3827
Mailing Address - Street 1:15865 SE 114TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9023
Mailing Address - Country:US
Mailing Address - Phone:503-305-3827
Mailing Address - Fax:503-253-9340
Practice Address - Street 1:15865 SE 114TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9023
Practice Address - Country:US
Practice Address - Phone:503-305-3827
Practice Address - Fax:503-253-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies