Provider Demographics
NPI:1447202668
Name:CASCADE CARDIOLOGY LLC
Entity Type:Organization
Organization Name:CASCADE CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING SPECI
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WIGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-485-4787
Mailing Address - Street 1:777 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3421
Mailing Address - Country:US
Mailing Address - Phone:503-485-4787
Mailing Address - Fax:503-485-4789
Practice Address - Street 1:777 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 130
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3421
Practice Address - Country:US
Practice Address - Phone:503-485-4787
Practice Address - Fax:503-485-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDB8768OtherRAILROAD MEDICARE
OR276218Medicaid
OR82569100OtherBLUE CROSS
ORR115605Medicare PIN