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General NPI Number Information
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NPI Number | 1215092010
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF COLORADO MEDICAL, P.C.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1109 FORD ST
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City | GOLDEN
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State | CO
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Zip | 80401-1176
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Country | US
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Telephone | 303-277-2138
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Fax | 303-277-6915
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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