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General NPI Number Information
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NPI Number | 1275355448
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF LOUISIANA MEDICAL PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2235 JACOB DR
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City | CHALMETTE
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State | LA
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Zip | 70043-5817
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Country | US
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Telephone | 504-278-6738
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Fax | 210-479-2010
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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 | JONATHAN B LEIZMAN
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Credential | MD
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Telephone | 615-468-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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