# SURGICAL SPECIALTY GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Colon & Rectal Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902978984
- **Authorized official:** MRS. OLGA MARIA VEIS (CLINIC MANAGER)
- **Authorized official phone:** (503) 222-1615

## Contact information

- **Practice address:** 511 SW 10TH AVENUE, SUITE 714, PORTLAND, OR 97205-2708
- **Practice address phone:** (503) 222-1615
- **Practice address fax:** (503) 222-0016
- **Mailing address:** 511 SW 10TH AVENUE, SUITE 714, PORTLAND, OR 97205-2708
- **Mailing address phone:** (503) 222-1615
- **Mailing address fax:** (503) 222-0016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 11/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 084061 | — | OR |