Provider Demographics
NPI:1528368883
Name:JAMES E. LISLE DPM LLC
Entity Type:Organization
Organization Name:JAMES E. LISLE DPM LLC
Other - Org Name:CASCADE FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER / PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-588-8188
Mailing Address - Street 1:3474 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4607
Mailing Address - Country:US
Mailing Address - Phone:503-588-8188
Mailing Address - Fax:503-588-0884
Practice Address - Street 1:3474 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4607
Practice Address - Country:US
Practice Address - Phone:503-588-8188
Practice Address - Fax:503-588-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00130213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0719520001Medicare NSC