PREMISE HEALTH OF OREGON MEDICAL P C NPI 1164197083

NPI Information

NPI: 1164197083
Provider Name: PREMISE HEALTH OF OREGON MEDICAL P C

Doing Business As: DTNA - PORTLAND

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
4709 N LAGOON AVE
PORTLAND, OR
ZIP 97217
Phone: (503) 745-7138
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PREMISE HEALTH OF OREGON MEDICAL P C is a multi-specialty clinic center in Portland, OR. PREMISE HEALTH OF OREGON MEDICAL P C NPI is 1164197083. The provider is registered as an organization entity type.
The provider Is Doing Business As Dtna - Portland.

The provider's business location address is:

4709 N LAGOON AVE
PORTLAND, OR
ZIP 97217-741
Phone: (503) 745-7138
Fax: (503) 745-6243

The provider's authorized official is Jonathan Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The enumeration date for this NPI number is 8/12/2021 and was last updated on 10/13/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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