Healthcare Provider Details

I. General information

NPI: 1972860781
Provider Name (Legal Business Name): PREMISE HEALTH EMPLOYER SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 CHALAN PASAHERU OLD COMMUTER TERMINAL
TAMUNING GU
96913
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 400
BRENTWOOD TN
37027-7048
US

V. Phone/Fax

Practice location:
  • Phone: 641-621-7670
  • Fax: 671-649-3872
Mailing address:
  • Phone: 844-407-7557
  • Fax: 671-649-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM D WRIGHT
Title or Position: SECRETARY/GENERAL COUNSEL
Credential:
Phone: 615-577-5893