Provider Demographics
NPI:1790805190
Name:CASCADE URGENT CARE, INC., PS
Entity Type:Organization
Organization Name:CASCADE URGENT CARE, INC., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMONIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-962-3303
Mailing Address - Street 1:1413 S 348TH STREET
Mailing Address - Street 2:106
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1413 S 348TH STREET
Practice Address - Street 2:L106
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8373
Practice Address - Country:US
Practice Address - Phone:800-962-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032782207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7137151Medicaid
WADG4033Medicare PIN
WAG8865287Medicare PIN