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1467648907 NPI number — PREMISE HEALTH OF INDIANA MEDICAL, P.C.

NPI Number: 1467648907
Health Care Provider/Practitioner: PREMISE HEALTH OF INDIANA MEDICAL, P.C.

Information about “1467648907” NPI (PREMISE HEALTH OF INDIANA MEDICAL, P.C.) exists in 1467648907 in HTML format HTML  |  1467648907 in plain Text format TXT  |  1467648907 in PDF (Portable Document Format) PDF  |  1467648907 in an XML format XML  formats.

NPI Number : 1467648907 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467648907",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMISE HEALTH OF INDIANA MEDICAL, P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5500 MARYLAND WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRENTWOOD",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37027-4948",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-865-9001",
    "MailingAddressFaxNumber": "217-709-2345",
    "FirstLinePracticeLocationAddress": "806 JACKSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47201-6264",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-377-6020",
    "PracticeLocationAddressFaxNumber": "812-377-6024",
    "EnumerationDate": "09/19/2007",
    "LastUpdateDate": "08/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEIZMAN",
    "AuthorizedOfficialFirstName": "JON",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "216-479-9063",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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