38D2111163 CLIA NUMBER - GRESHAM STATION DIALYSIS

Laboratory Demographics

  • CLIA Code: 38D2111163
  • Facility Name: GRESHAM STATION DIALYSIS
  • Facility Address: 878 NW BURNSIDE RD
    GRESHAM, OR
    ZIP 97030
  • Facility Phone: 503 465-1068
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SONIA V BYNUM MD
  • NPI Number: 1932568912
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2111163
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GRESHAM STATION DIALYSIS
Street 878 NW BURNSIDE RD
City GRESHAM
State OR
ZIP 97030
Phone 503 465-1068
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SONIA V BYNUM MD

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This page was last updated on: 9/29/2025