| Cascade Clinic Walk In And Primary Care Llc | |
|
1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 | |
| (360) 899-4086 | |
| (360) 899-4124 |
| Full Name | Cascade Clinic Walk In And Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1420 Roosevelt Ave Ste 4, Mount Vernon, Washington |
| Authorized Official Name and Position | Kathy Bradford (OWNER) |
| Authorized Official Contact | 3607704690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cascade Clinic Walk In And Primary Care Llc 1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 Ph: (608) 994-0863 | Cascade Clinic Walk In And Primary Care Llc 1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 Ph: (360) 899-4086 |
| NPI Number | 1609121854 |
|---|---|
| Provider Enumeration Date | 07/13/2012 |
| Last Update Date | 05/07/2020 |
| Medicare PECOS PAC ID | 4486800141 |
|---|---|
| Medicare Enrollment ID | O20120813000105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609121854 | NPI | - | NPPES |
| 321303 | Other | WA | LABOR AND INDUSTRIES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kathy Y Bradford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871802769 PECOS PAC ID: 3173712882 Enrollment ID: I20110112000213 |
| Provider Name | Marcia Rene Kucera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003362088 PECOS PAC ID: 4587952486 Enrollment ID: I20161010000654 |
| Provider Name | Anne Marie Hardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871061606 PECOS PAC ID: 4082948419 Enrollment ID: I20190619000191 |
| Provider Name | Emma Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053075416 PECOS PAC ID: 7113377748 Enrollment ID: I20231222001538 |
| Provider Name | Rhonda Eisenberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699423285 PECOS PAC ID: 2961852355 Enrollment ID: I20231227002713 |
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