Provider Demographics
NPI:1669437497
Name:CASCADE SURGICENTER, LLC
Entity type:Organization
Organization Name:CASCADE SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILSTRAP
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL DIRECTOR
Authorized Official - Phone:541-330-8671
Mailing Address - Street 1:2200 NE NEFF ROAD,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-330-8671
Mailing Address - Fax:541-322-2394
Practice Address - Street 1:2200 NE NEFF ROAD,
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-330-8671
Practice Address - Fax:541-322-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QR0405X
OR08-00002864261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
197167600OtherBLUE CROSS
OR33601OtherPACIFIC SOURCE HEALTH PLAN
269786OtherOMAP
OR38C0001068OtherCCN (CMS CERTIFICATION NUMBER)
610406200OtherUS DEPT OF LABOR
338161OtherPROVIDENCE HP
197475OtherWA DEPT OF LABOR
P333601OtherPACIFIC SOURCE
269786OtherOMAP
P333601OtherPACIFIC SOURCE
ORP00264781Medicare PIN
OR131720Medicare PIN
OR33601OtherPACIFIC SOURCE HEALTH PLAN
197167600OtherBLUE CROSS
P00264781Medicare ID - Type UnspecifiedRAILROAD