BURNSIDE SURGERY CENTER LLC (NPI# 1013417351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013417351 |
| Entity Type | Organization |
| Organization Name | BURNSIDE SURGERY CENTER LLC |
| Practice Address |
689 Nw Burnside Rd Fl 1 Gresham OR 97030-3739 |
| Practice Telephone | 5033828140 |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-13 |
| Authorized Official Name | DR. OLEG MAKSIMOV (DIRECTOR) |
| Authorized Official Telephone | 5039159217 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
MD28526 | OR | Allopathic & Osteopathic Physicians |
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
07-1645 | OR | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | BURNSIDE SURGERY CENTER LLC | 689 Nw Burnside Rd, Gresham, OR 97030 |
| Street Address |
689 NW BURNSIDE RD FL 1 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235195447 | Gresham Station Surgery Center LLC | Clinic/Center | 831 Nw Council Drive, Suite 212, Gresham, OR 97030 | 2006-04-25 |
| 1003914243 | Stark Street Plaza, LLC | Clinic/Center | 24076 Se Stark St, Suite 310, Gresham, OR 97030-3373 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457826125 | Central Oregon Surgical Institute, LLC | Clinic/Center | 1550 Ne 27th St Ste 110, Bend, OR 97701-7728 | 2018-10-09 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1962920751 | West End Surgical, LLC | Clinic/Center | 9405 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-09-01 |
| 1588181275 | Chase Gardens Surgery Center LLC | Clinic/Center | 360 S Garden Way Ste 100, Eugene, OR 97401-8173 | 2017-08-24 |
| 1164946984 | Northwest Renal Clinic, Inc. | Clinic/Center | 9701 Sw Barnes Rd Ste 110, Portland, OR 97225-6774 | 2017-08-02 |
| 1679939318 | Crater Lake Surgery Center LLC | Clinic/Center | 833 Bennett Ave, Medford, OR 97504-6715 | 2016-01-11 |
| 1902287469 | Gateway Dental Surgery Center | Clinic/Center | 10535 Ne Glisan St Ste 101, Portland, OR 97220-4095 | 2015-06-10 |
| 1760861835 | Central Oregon Surgery Center LLC | Clinic/Center | 1835 Nw Pence Ln Ste 100, Bend, OR 97703-1551 | 2015-05-22 |
| 1972902286 | Oregon Specialists Surgery Center LLC | Clinic/Center | 2785 River Rd S, Salem, OR 97302-5883 | 2014-08-22 |
| 1649612698 | Willamette Procedure Center PC | Clinic/Center | 2020 8th Ave Ste 212, West Linn, OR 97068-4657 | 2013-07-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.