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General NPI Number Information
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NPI Number | 1164732061
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF TEXAS MEDICAL, P.A
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1701 E MOSSY OAK ROAD
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City | SPRING
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State | TX
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Zip | 77389-1433
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Country | US
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Telephone | 972-398-9147
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Fax | 972-398-9148
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY STE 120
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City | BRENTWOOD
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State | TN
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Zip | 37027-4993
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. 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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