NPIMap

Organization Active NPI

Columbia Gorge Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • The Dalles, OR
National Provider Identifier
1386898435
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
COLUMBIA GORGE SURGERY CENTER, LLC
Practice address
1020 Webber St
The Dalles, OR 97058
Phone
(541) 431-0665
Fax
(541) 431-3288
NPI assigned
Nov 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mandy Jones
Title
Executive Director
Phone
(541) 769-0426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1020 Webber St
The Dalles, OR 97058

Mailing address

1020 Webber St
The Dalles, OR 97058-3749
Phone (541) 769-0426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100304000291 OR Part B Supplier - Ambulatory Surgical Center 2062557846 Practice locations: The Dalles, OR

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Columbia Gorge Surgery Center LLCCCN 38C0001091
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1095453Columbia Gorge Surgery Center LLC1020 Webber Street, The Dalles, OR 97058Certificate of waiverFeb 8, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1386898435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 WEBBER ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583749",
            "telephone_number": "541-769-0426",
            "fax_number": "541-769-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 WEBBER ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "97058",
            "telephone_number": "541-431-0665",
            "fax_number": "541-431-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA GORGE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-769-0426"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in The Dalles, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.