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General NPI Number Information
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NPI Number | 1528345550
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF WASHINGTON MEDICAL, P.C
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 747 6TH ST S
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City | KIRKLAND
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State | WA
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Zip | 98033-6715
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Country | US
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Telephone | 650-214-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY SUITE 400
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City | BRENTWOOD
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State | TN
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Zip | 37027-4948
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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 | JON LEIZMAN
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Credential |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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