Provider Demographics
NPI:1376692129
Name:STUART CARDON
Entity Type:Organization
Organization Name:STUART CARDON
Other - Org Name:CASCADE FOOT AND ANKLE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-225-3668
Mailing Address - Street 1:2400 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6109
Mailing Address - Country:US
Mailing Address - Phone:509-225-3668
Mailing Address - Fax:509-225-3448
Practice Address - Street 1:2400 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6109
Practice Address - Country:US
Practice Address - Phone:509-225-3668
Practice Address - Fax:509-225-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000565261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7142219Medicaid
WAG8867656Medicare PIN