Healthcare Provider Details

I. General information

NPI: 1730471509
Provider Name (Legal Business Name): PREMISE HEALTH OF OHIO MEDICAL, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 4TH ST
CINCINNATI OH
45202-4245
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 513-287-8260
  • Fax: 513-287-8263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN B LEIZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 844-407-7557