Provider Demographics
NPI:1477616936
Name:CASCADE HERNIA AND SURGICAL SOLUTIONS PS
Entity Type:Organization
Organization Name:CASCADE HERNIA AND SURGICAL SOLUTIONS PS
Other - Org Name:MERIDIAN SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:253-840-1999
Mailing Address - Street 1:208 17TH AVE SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4515
Mailing Address - Country:US
Mailing Address - Phone:253-840-1999
Mailing Address - Fax:253-445-4125
Practice Address - Street 1:208 17TH AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4515
Practice Address - Country:US
Practice Address - Phone:253-840-1999
Practice Address - Fax:253-445-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00057051208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5353MEOtherREGENCE BLUE SHIELD