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General NPI Number Information
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NPI Number | 1104114529
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF OHIO MEDICAL, P.A
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 100 W BURTON ST
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City | MURFREESBORO
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State | TN
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Zip | 37130-3657
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Country | US
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Telephone | 615-898-7880
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Fax |
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Provider Business Mailing Address
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Address Line | 205 MILLER SPRINGS COURTS
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City | FRANKLIN
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State | TN
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Zip | 37064-5434
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Country | US
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Telephone | 615-898-7880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON LEIZMAN
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Credential | MD
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Telephone | 216-479-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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