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Organization
GRESHAM STATION SURGERY CENTER LLC
Active
Organization
GRESHAM STATION SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAY SKINNER RN (ADMINISTRATOR)
(503) 907-1907
Entity
Organization
Contact information
Practice address
831 NW COUNCIL DRIVE, SUITE 212, GRESHAM, OR 97030
(503) 907-1907
(503) 489-2073
Mailing address
831 NW COUNCIL DRIVE, SUITE 212, GRESHAM, OR 97030
(503) 907-1907
(503) 489-2073
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
07-1567
OR
261QA1903X
Ambulatory Surgical Clinic/Center
394819
OR
Other
Enumeration date
04/25/2006
Last updated
05/04/2010
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