# CASCADE PHYSICIANS, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639210610
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINO (DIRECTORS OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 19250 SW 65TH AVE, 110, TUALATIN, OR 97062-7452
- **Practice address phone:** (503) 692-1205
- **Mailing address:** PO BOX 86309, PORTLAND, OR 97286-0309
- **Mailing address phone:** (503) 242-9850
- **Mailing address fax:** (503) 226-3539

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 332900000X | Non-Pharmacy Dispensing Site | MD13393 | OR | — |

## Other

- **Enumeration date:** 02/10/2007
- **Last updated:** 01/26/2023