Provider Demographics
NPI:1639454903
Name:CASCADE CARDIOLOGY LLC
Entity Type:Organization
Organization Name:CASCADE CARDIOLOGY LLC
Other - Org Name:CASCADE CARDIOLOGY WILLAMETTE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:C
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:
Practice Address - Street 1:777 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0060
Practice Address - Country:US
Practice Address - Phone:503-485-4787
Practice Address - Fax:503-485-4789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADE CARDIOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-18
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty