# GRESHAM STATION SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1235195447
- **Authorized official:** MICHAEL RAY SKINNER RN (ADMINISTRATOR)
- **Authorized official phone:** (503) 907-1907

## Contact information

- **Practice address:** 831 NW COUNCIL DRIVE, SUITE 212, GRESHAM, OR 97030
- **Practice address phone:** (503) 907-1907
- **Practice address fax:** (503) 489-2073
- **Mailing address:** 831 NW COUNCIL DRIVE, SUITE 212, GRESHAM, OR 97030
- **Mailing address phone:** (503) 907-1907
- **Mailing address fax:** (503) 489-2073

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 07-1567 | OR | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 394819 | OR | — |

## Other

- **Enumeration date:** 04/25/2006
- **Last updated:** 05/04/2010