Provider Demographics
NPI:1255795738
Name:CASCADE INTEGRATIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:CASCADE INTEGRATIVE MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:JAMEEL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-391-5270
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-5270
Mailing Address - Fax:425-391-8091
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:STE 201
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-5270
Practice Address - Fax:425-391-8091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADE INTEGRATIVE MEDICINE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-11
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60121488332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site