Basic Information
| Provider Information | |||||||||
| NPI: | 1427028919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE ENDOSCOPY CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CASCADE ENDOSCOPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1A BURTON HILLS BLVD # L&C | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152403820 | ||||||||
| FaxNumber: | 6152341720 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 HARLOW ROAD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417268882 | ||||||||
| FaxNumber: | 5417268844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNODGRASS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 274838 | 05 | OR | MEDICAID |