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Organization
PREMISE HEALTH OF OREGON MEDICAL P C
Active
Organization
PREMISE HEALTH OF OREGON MEDICAL P C
Active
Other names
DTNA - Portland Occ
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
6936 N FATHOM ST, PORTLAND, OR 97217-3928
(971) 717-6307
(971) 717-6492
Mailing address
5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/18/2021
Last updated
10/13/2022
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