Provider Demographics
NPI:1366512949
Name:CASCADE PROSTHETICS AND ORTHOTICS, INC.
Entity type:Organization
Organization Name:CASCADE PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-384-1858
Mailing Address - Street 1:1360 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8913
Mailing Address - Country:US
Mailing Address - Phone:360-384-1858
Mailing Address - Fax:360-384-1927
Practice Address - Street 1:17670 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8752
Practice Address - Country:US
Practice Address - Phone:360-428-4003
Practice Address - Fax:360-428-7072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADE PROSTHETICS AND ORTHOTICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR066332Medicaid
WA18028OtherSTATE LABOR & INDUSTRIES
WA9497900Medicaid
OR066332Medicaid