Organization
BURNSIDE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLEG MAKSIMOV (DIRECTOR)
(503) 915-9217
Entity
Organization
Contact information
Practice address
689 NW BURNSIDE RD FL 1, GRESHAM, OR 97030-3739
(503) 382-8140
Mailing address
689 NW BURNSIDE RD FL 1, GRESHAM, OR 97030-3739
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD28526
OR
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
07-1645
OR
Other
Enumeration date
02/13/2018
Last updated
05/23/2021
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