Provider Demographics
NPI:1518909076
Name:CASCADE MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:CASCADE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-548-2164
Mailing Address - Street 1:211 NW LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1357
Mailing Address - Country:US
Mailing Address - Phone:541-548-2164
Mailing Address - Fax:541-548-0534
Practice Address - Street 1:211 NW LARCH AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1357
Practice Address - Country:US
Practice Address - Phone:541-548-2164
Practice Address - Fax:541-548-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00WCJNRMedicare ID - Type Unspecified
OR0554990001Medicare NSC