Provider Demographics
NPI: | 1114221033 |
---|---|
Name: | PREMISE HEALTH OF FLORIDA MEDICAL, P.A. |
Entity Type: | Organization |
Organization Name: | PREMISE HEALTH OF FLORIDA MEDICAL, P.A. |
Other - Org Name: | NEE HEALTH AND WELLBEING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JONATHAN |
Authorized Official - Middle Name: | |
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 |
Mailing Address - Street 2: | |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-4948 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 877-865-9013 |
Mailing Address - Fax: | 305-569-4124 |
Practice Address - Street 1: | 4200 W FLAGLER ST |
Practice Address - Street 2: | |
Practice Address - City: | CORAL GABLES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33134-1606 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-569-4125 |
Practice Address - Fax: | 305-569-4124 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-01-06 |
Last Update Date: | 2022-08-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |