Provider Demographics
NPI:1376573279
Name:CARDIOVASCULAR CONSULTANTS OF THE CASCADES LLP
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF THE CASCADES LLP
Other - Org Name:HEART CENTER CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-388-4333
Mailing Address - Street 1:PO BOX 6419
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6419
Mailing Address - Country:US
Mailing Address - Phone:541-388-4333
Mailing Address - Fax:541-633-2569
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-388-4333
Practice Address - Fax:541-633-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDA6873OtherRAIL ROAD MEDICARE
OR227682Medicaid
OR227682Medicaid