Provider Demographics
NPI:1063622355
Name:CASCADE FAMILY MEDICINE, P.S.
Entity type:Organization
Organization Name:CASCADE FAMILY MEDICINE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:D,O,
Authorized Official - Phone:360-254-4402
Mailing Address - Street 1:406 SE 131ST AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4004
Mailing Address - Country:US
Mailing Address - Phone:360-254-4402
Mailing Address - Fax:360-892-9241
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:SUITE 203 B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-254-4402
Practice Address - Fax:360-892-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7051428Medicaid
WA=========OtherCORP TAX ID #