Healthcare Provider Details

I. General information

NPI: 1396079984
Provider Name (Legal Business Name): PREMISE HEALTH OF OHIO MEDICAL, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CARDINAL PLACE
DUBLIN OH
43017-1091
US

IV. Provider business mailing address

205 MILLER SPRINGS CT ATTN:CBO
FRANKLIN TN
37064-5434
US

V. Phone/Fax

Practice location:
  • Phone: 614-553-3830
  • Fax: 614-553-3831
Mailing address:
  • Phone: 888-830-4255
  • Fax: 615-296-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON LEIZMAN
Title or Position: PRESIDENT
Credential:
Phone: 216-479-9063