PREMISE HEALTH OF OREGON MEDICAL P.C. NPI 1992470504

NPI Information

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 1992470504. The provider is registered as an organization entity type.
The provider Is Doing Business As Leatherman - Portland.

The provider's business location address is:

12106 NE AINSWORTH CIR STE 5
PORTLAND, OR
ZIP 97220-001
Phone: (541) 225-5551
Fax: (301) 244-0995

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 CLIA number assigned to this NPI record is 38D2145671 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2021 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:

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