# PREMISE HEALTH OF OREGON MEDICAL P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Occupational Health Services Roncler Acres 4
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700526092
- **Authorized official:** JONATHAN LEIZMAN (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 2501 NE CENTURY BLVD, HILLSBORO, OR 97124-5506
- **Practice address phone:** (502) 613-6266
- **Practice address fax:** (503) 214-5886
- **Mailing address:** 5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993

## Taxonomy

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

## Other

- **Enumeration date:** 04/01/2022
- **Last updated:** 10/13/2022