# BURNSIDE SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013417351
- **Authorized official:** DR. OLEG MAKSIMOV (DIRECTOR)
- **Authorized official phone:** (503) 915-9217

## Contact information

- **Practice address:** 689 NW BURNSIDE RD FL 1, GRESHAM, OR 97030-3739
- **Practice address phone:** (503) 382-8140
- **Mailing address:** 689 NW BURNSIDE RD FL 1, GRESHAM, OR 97030-3739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | MD28526 | OR | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 07-1645 | OR | Yes |

## Other

- **Enumeration date:** 02/13/2018
- **Last updated:** 05/23/2021