Provider Demographics
NPI:1467479303
Name:COLUMBIA SURGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:COLUMBIA SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:COWELL, JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-667-4000
Mailing Address - Street 1:25500 SE STARK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8327
Mailing Address - Country:US
Mailing Address - Phone:503-667-4000
Mailing Address - Fax:503-661-0835
Practice Address - Street 1:25500 SE STARK ST STE 101
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8327
Practice Address - Country:US
Practice Address - Phone:503-667-4000
Practice Address - Fax:503-661-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150464Medicaid
OR113548Medicare ID - Type UnspecifiedMEDICARE
OR150464Medicaid