Provider Demographics
NPI:1346228699
Name:CASCADE PROSTHETICS AND ORTHOTICS INC
Entity Type:Organization
Organization Name:CASCADE PROSTHETICS AND ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-384-1858
Mailing Address - Street 1:1360 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8913
Mailing Address - Country:US
Mailing Address - Phone:360-384-1858
Mailing Address - Fax:360-384-1927
Practice Address - Street 1:1360 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8913
Practice Address - Country:US
Practice Address - Phone:360-384-1858
Practice Address - Fax:360-384-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600446461332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90032681Medicaid
AKPO576WAMedicaid
HI00630201Medicaid
KS1002111404Medicaid
MS00440415Medicaid
MO6738087OtherBSHCN 1ST STEPS
INCAJ52110OtherCSHCN
ID003256500Medicaid
MN090765100Medicaid
MT0510029Medicaid
IA0986836Medicaid
IN100027950AMedicaid
AZ527806OtherAHCCCS
CO98001894Medicaid
DC0701450OtherHSCSN
LA1934071Medicaid
MA844600800Medicaid
IA0986836Medicaid
LA1934071Medicaid
ID003256500Medicaid