Provider Demographics
NPI:1154465656
Name:CASCADE PATHOLOGY SERVICES, CORP
Entity Type:Organization
Organization Name:CASCADE PATHOLOGY SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATTENDICK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:561-514-5822
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4207
Mailing Address - Country:US
Mailing Address - Phone:503-268-4850
Mailing Address - Fax:503-268-4801
Practice Address - Street 1:1225 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2003
Practice Address - Country:US
Practice Address - Phone:503-413-5049
Practice Address - Fax:503-413-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037486Medicaid
ORR0000WCMBLMedicare PIN
OR2200008930Medicare PIN