MEDICARE: PREMISE HEALTH OF OREGON MEDICAL P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1164197083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF OREGON MEDICAL P C

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 N LAGOON AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-7741
Country	:	US
Telephone Number	:	503-745-7138
Fax Number	:	503-745-6243

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD WILLIAM SCHWARTZ
Credential	:
Telephone Number	:	844-407-7557

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	02/02/2026

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