MEDICARE: PREMISE HEALTH OF OHIO MEDICAL, P.A

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
1	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1548589575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF OHIO MEDICAL, P.A

Provider Business Mailing Address
First Line	:	205 MILLERSPRINGS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5434
Country	:	US
Telephone Number	:	615-468-7820
Fax Number	:	615-468-3495

Provider Business Practice Location Address
First Line	:	205 MILLERSPRINGS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5434
Country	:	US
Telephone Number	:	615-468-7820
Fax Number	:	615-468-3495

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JON LEIZMAN
Credential	:	M.D.
Telephone Number	:	216-479-9063

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	08/16/2022

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