Provider Demographics
NPI:1396431474
Name:CASCADE REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:CASCADE REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, RMSK
Authorized Official - Phone:503-914-8455
Mailing Address - Street 1:6420 S MACADAM AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3518
Mailing Address - Country:US
Mailing Address - Phone:503-841-5292
Mailing Address - Fax:
Practice Address - Street 1:6420 S MACADAM AVE STE 208
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3518
Practice Address - Country:US
Practice Address - Phone:503-841-5292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty