Provider Demographics
NPI:1538595475
Name:PREMISE HEALTH OF TENNESSEE MEDICAL, P.C
Entity type:Organization
Organization Name:PREMISE HEALTH OF TENNESSEE MEDICAL, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEIZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-479-9063
Mailing Address - Street 1:5500 MARYLAND WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 BUECHEL BANK RD
Practice Address - Street 2:APPLIANCE PARK AP4-100 MEDICAL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40225-0001
Practice Address - Country:US
Practice Address - Phone:502-452-0777
Practice Address - Fax:502-452-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty