38D2150925 CLIA NUMBER - BURNSIDE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 38D2150925
  • Facility Name: BURNSIDE SURGERY CENTER
  • Facility Address: 689 NW BURNSIDE ROAD
    GRESHAM, OR
    ZIP 97030
  • Facility Phone: 503 382-8152
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: OLEG I. MAKSIMOV MD
  • NPI Number: 1013417351
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2150925
LAB Type Ambulatory Surgery Center
Facility Name BURNSIDE SURGERY CENTER
Street 689 NW BURNSIDE ROAD
City GRESHAM
State OR
ZIP 97030
Phone 503 382-8152
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Ambulatory Surgery Center
Lab Director OLEG I. MAKSIMOV MD

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This page was last updated on: 6/4/2025