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General NPI Number Information
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NPI Number | 1750633137
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF VIRGINIA MEDICAL, P.C
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 1001 SEMMES AVE FIRST FLOOR
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City | RICHMOND
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State | VA
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Zip | 23224-2245
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Country | US
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Telephone | 804-404-0107
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Fax |
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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 | 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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