| Premise Health Of Oregon Medical, P.c. | |
|
4000 Ne Blue Lake Rd Fairview OR 97024-8710 | |
| (503) 721-6040 | |
| (256) 883-3674 |
| Full Name | Premise Health Of Oregon Medical, P.c. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4000 Ne Blue Lake Rd, Fairview, Oregon |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of Oregon Medical, P.c. 5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | Premise Health Of Oregon Medical, P.c. 4000 Ne Blue Lake Rd Fairview OR 97024-8710 Ph: (503) 721-6040 |
| NPI Number | 1457026056 |
|---|---|
| Provider Enumeration Date | 08/16/2021 |
| Last Update Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457026056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |