National Provider Identifier Database

GRESHAM STATION SURGERY CENTER LLC
Ambulatory Surgical


Contact Information

GRESHAM STATION SURGERY CENTER LLC
831 NW COUNCIL DRIVE
SUITE 212
GRESHAM, OR97030
Phone: 503-907-1907
Fax: 503-489-2073
Website:
Specialty Taxonomy Code
* Ambulatory Surgical 261QA1903X

* Indicates primary specialty

NPI Profile & details for GRESHAM STATION SURGERY CENTER LLC

NPI Number 1235195447
Legal business name
LBN
GRESHAM STATION SURGERY CENTER LLC
Authorized official MICHAEL SKINNER - (ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 04/25/2006
Last updated 05/04/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers
  • OR License #: 07-1567
  • OR License #: 394819
  • OR Medicaid: 213664

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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