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General NPI Number Information
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NPI Number | 1588972426
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, P.C
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 10 PARKWAY SOUTH
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City | GREENVILLE
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State | SC
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Zip | 29615
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Country | US
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Telephone | 864-458-6933
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY
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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 | 888-830-4255
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Fax | 615-296-0151
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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 | M.D.
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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