Provider Demographics
NPI:1649378076
Name:CASCADE SUMMIT FAMILY PRACTICE PC
Entity type:Organization
Organization Name:CASCADE SUMMIT FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TREMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-657-6010
Mailing Address - Street 1:22400 S SALAMO ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068
Mailing Address - Country:US
Mailing Address - Phone:503-657-6010
Mailing Address - Fax:503-655-0753
Practice Address - Street 1:22400 S SALAMO ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:503-657-6010
Practice Address - Fax:503-655-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR114058Medicare ID - Type Unspecified