Healthcare Provider Details

I. General information

NPI: 1427112648
Provider Name (Legal Business Name): PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E HALL OF FAME AVE
STILLWATER OK
74075-5428
US

IV. Provider business mailing address

40 BURTON HILLS BLVD SUITE 200
NASHVILLE TN
37215-6155
US

V. Phone/Fax

Practice location:
  • Phone: 800-370-1192
  • Fax: 405-707-3015
Mailing address:
  • Phone: 615-565-1733
  • Fax: 615-296-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LEIZMAN
Title or Position: PC OWNER
Credential: M.D.
Phone: 216-479-9063