Provider Demographics
NPI:1871794438
Name:CASCADE SURGICAL PARTNERS, PLLC
Entity type:Organization
Organization Name:CASCADE SURGICAL PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-575-3946
Mailing Address - Street 1:3003 TIETON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3679
Mailing Address - Country:US
Mailing Address - Phone:509-575-3946
Mailing Address - Fax:509-225-6449
Practice Address - Street 1:3003 TIETON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3679
Practice Address - Country:US
Practice Address - Phone:509-575-3946
Practice Address - Fax:509-225-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044226208600000X
WAMD00021997208600000X
WAMD00034873208600000X
WA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1326107Medicaid
WA8207797Medicaid
WA8264889Medicaid
WA8415531Medicaid
WA8415531Medicaid
WAAB39323Medicare ID - Type UnspecifiedROBERT J CONROY, MD
WA8264889Medicaid
WAG47425Medicare UPIN
WAA06533Medicare UPIN
WAAB39323Medicare ID - Type UnspecifiedBARRY D BERNFELD
WA1326107Medicaid
WAG63454Medicare UPIN