# PREMISE HEALTH OF OREGON MEDICAL P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DTNA - Portland Occ
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134895410
- **Authorized official:** JONATHAN LEIZMAN (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 6936 N FATHOM ST, PORTLAND, OR 97217-3928
- **Practice address phone:** (971) 717-6307
- **Practice address fax:** (971) 717-6492
- **Mailing address:** 5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/18/2021
- **Last updated:** 10/13/2022