Basic Information
| Provider Information | |||||||||
| NPI: | 1073797965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE VALLEY ANESTHESIA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94156 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253533788 | ||||||||
| FaxNumber: | 4253538041 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 S STILLAGUAMISH AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253533788 | ||||||||
| FaxNumber: | 4253538041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHAMBERLAIN | ||||||||
| AuthorizedOfficialFirstName: | DERMOT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4253533788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 602785732 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.