Basic Information
Provider Information | |||||||||
NPI: | 1215985502 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CASCADE SURGERY ASSOCIATES, PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | AUBURN NEUROLOGICAL INSTITUTE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 35142 #698909 | ||||||||
Address2: |   | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981245142 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2533336960 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 125 3RD ST NE STE 402 | ||||||||
Address2: |   | ||||||||
City: | AUBURN | ||||||||
State: | WA | ||||||||
PostalCode: | 980024035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2533331637 | ||||||||
FaxNumber: | 2533518509 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2006 | ||||||||
LastUpdateDate: | 01/11/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TRIVEDI | ||||||||
AuthorizedOfficialFirstName: | ASHISH | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
AuthorizedOfficialTelephone: | 2533331637 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 7066277 | 05 | WA |   | MEDICAID | 8917098 | 01 | WA | L&I GROUP | OTHER | CN8221 | 01 | WA | RAIRLROAD MEDICARE | OTHER | CG6198 | 01 | WA | RAILROAD MEDICARE | OTHER |