Provider Demographics
NPI:1437280120
Name:CASCASDE OCCUPATIONAL MEDICINE PHYSICIANS INC
Entity Type:Organization
Organization Name:CASCASDE OCCUPATIONAL MEDICINE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:BRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-635-1960
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-0748
Mailing Address - Country:US
Mailing Address - Phone:503-635-1960
Mailing Address - Fax:503-635-8354
Practice Address - Street 1:4000 KRUSE WAY PL
Practice Address - Street 2:BUILDING 2, SUITE 160
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5545
Practice Address - Country:US
Practice Address - Phone:503-635-1960
Practice Address - Fax:503-635-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine