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CASCADE MEDICAL GROUP, P.S., INC.

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Company Details

Legal Name: CASCADE MEDICAL GROUP, P.S., INC.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Inactive
Formation/ Registration Date: September 30th 1976
Date of Dissolution: January 1st 2014
Expiration date: 30 Sep 2014
UBI Number: 600 209 721

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Registered Agent Information

Name Role Address
GARY K JOHNSON Registered Agent 111 S 13TH ST, MOUNT VERNON, WA, 98274-4105, UNITED STATES

Key Officers & Management

Name Role Address
KEVIN HARRIS Governing Person 4209 GLASGOW WAY, ANACORTES, WA, 98221, UNITED STATES
GARY BROWN Governing Person 15308 BARRETT RD, MOUNT VERNON, WA, 98273, UNITED STATES
GARY JOHNSON Governing Person 16936 LAKEVIEW BLVD, MOUNT VERNON, WA, 98273, UNITED STATES
JAMES GROSS Governing Person 22516 CULLY RD, SEDRO WOOLLEY, WA, 98284, UNITED STATES

National Provider Identifier

NPI Number:
1588631287
Link:
View on NPI website

Authorized Person:

Name:
GARY L BROWN
Role:
MEDICAL DIRECTOR
Phone:
3603362178

Taxonomy:

Selected Taxonomy:
207YS0123X - Facial Plastic Surgery Physician
Is Primary:
No
Selected Taxonomy:
207Y00000X - Otolaryngology Physician
Is Primary:
No
Selected Taxonomy:
207YX0602X - Otolaryngic Allergy Physician
Is Primary:
No
Selected Taxonomy:
2086S0122X - Plastic and Reconstructive Surgery Physician
Is Primary:
No
Selected Taxonomy:
2086X0206X - Surgical Oncology Physician
Is Primary:
No
Selected Taxonomy:
208200000X - Plastic Surgery Physician
Is Primary:
No
Selected Taxonomy:
2082S0099X - Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Is Primary:
No
Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
No
Selected Taxonomy:
207YX0905X - Otolaryngology/Facial Plastic Surgery Physician
Is Primary:
Yes

Contacts:

Phone:
+1 360-336-2178
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