Provider Demographics
NPI:1265499180
Name:CASCADE SURGERY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CASCADE SURGERY ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-833-7750
Mailing Address - Street 1:PO BOX 35142 #698909
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5142
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:253-833-7469
Practice Address - Street 1:122 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4013
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:253-833-7469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADE SURGERY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7066277Medicaid
WA75850OtherL&I GROUP
WACN8221OtherMEDICARE RR GRP
WA1169950001Medicare NSC
WAG217110100Medicare PIN