Provider Demographics
NPI:1235307265
Name:CASCADE CENTER FOR PLASTIC & RECON SURGERY
Entity Type:Organization
Organization Name:CASCADE CENTER FOR PLASTIC & RECON SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:541-480-1828
Mailing Address - Street 1:2100 NE NEFF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6213
Mailing Address - Country:US
Mailing Address - Phone:541-388-3006
Mailing Address - Fax:541-382-7605
Practice Address - Street 1:2100 NE NEFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6213
Practice Address - Country:US
Practice Address - Phone:541-388-3006
Practice Address - Fax:541-382-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18444208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR104089Medicare UPIN