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General NPI Number Information
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NPI Number | 1619238797
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF MASSACHUSETTS, MEDICAL PC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 41 MALL RD
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8796
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Fax | 781-744-5044
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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 | 877-865-9013
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Fax | 217-709-2345
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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