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Organization

CASCADE SURGICENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAMMY GILSTRAP CLINICAL DIRECTOR (CLINICAL DIRECTOR)
(541) 330-8671
Entity
Organization

Contact information

Practice address
2200 NE NEFF ROAD,, SUITE 100, BEND, OR 97701
(541) 330-8671
(541) 322-2394
Mailing address
2200 NE NEFF ROAD,, SUITE 100, BEND, OR 97701
(541) 330-8671
(541) 322-2394

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
08-00002864
OR
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
197167600
BLUE CROSS
01
197475
WA DEPT OF LABOR
01
269786
OMAP
01
33601
PACIFIC SOURCE HEALTH PLAN
OR
01
338161
PROVIDENCE HP
01
38C0001068
CCN (CMS CERTIFICATION NUMBER)
OR
01
610406200
US DEPT OF LABOR
01
P333601
PACIFIC SOURCE
Enumeration date
04/17/2006
Last updated
07/21/2022
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