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NPI Code Detail

MEDICARE: PREMISE HEALTH OF COLORADO MEDICAL, P.C.

MEDICARE: PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1316242936
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Provider Business Mailing Address
First Line : 5500 MARYLAND WAY STE 120
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-4993
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1670 BROADWAY STE 2200
Second Line : HEALTH SERVICES, 5TH FLOOR
City : DENVER
State : CO
Zip : 80202-4802
Country : US
Telephone Number : 303-607-2572
Fax Number : 303-626-4780
Authorized Official
Title or Position : PRESIDENT
Name : DR. JON LEIZMAN
Credential : MD
Telephone Number : 216-479-9063
Provider Enumeration Date : 01/12/2011
Last Update Date : 08/23/2022

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Directions to “PREMISE HEALTH OF COLORADO MEDICAL, P.C. ” Practice Location

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