Provider Demographics
NPI:1609887413
Name:CSS JV, LLC
Entity Type:Organization
Organization Name:CSS JV, LLC
Other - Org Name:CENTER FOR SPECIALTY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-906-4306
Mailing Address - Street 1:11782 SW BARNES RD
Mailing Address - Street 2:#200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5914
Mailing Address - Country:US
Mailing Address - Phone:503-906-4300
Mailing Address - Fax:503-906-4333
Practice Address - Street 1:11782 SW BARNES RD
Practice Address - Street 2:#200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5914
Practice Address - Country:US
Practice Address - Phone:503-906-4300
Practice Address - Fax:503-906-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274836Medicaid
ORR117170Medicare PIN
OR117170Medicare ID - Type UnspecifiedMEDICARE #