South Portland Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTH PORTLAND SURGICAL CENTER LLC

Doing business as

South Portland Surgical Center

Practice address

6370 SW Borland Rd
Suite 100
Tualatin, OR 97062-9754

Phone

(503) 218-1105

NPI assigned

Sep 7, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other names 1

• South Portland Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

South Portland Surgical CenterCCN 38C0001095

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1841507266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD",
            "address_2": "ATTN: L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156187",
            "telephone_number": "615-240-3820",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6370 SW BORLAND RD",
            "address_2": "SUITE 100",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629754",
            "telephone_number": "503-218-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PORTLAND SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-07",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Portland Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Portland Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Took Smoot
• Fenya B Snegirev
• Susan Dale Snow, MD
• Jean Snyder, BS-DTR
• Francisco X Soldevilla, MD
• Spinal Diagnostics PC
• Sports Orthopaedic and Regenerative Medicine Clinic of Oregon, LLC
• Sprague Counseling and Consulting, LLC
• Madeline Louise Stafford
• Stand by Me LLC

• Ambulatory Surgical Clinic/Center in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.