Provider Demographics
NPI:1164292090
Name:PREMONITION HEALTH LLC
Entity Type:Organization
Organization Name:PREMONITION HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LINDEN
Authorized Official - Last Name:BEZZANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-789-6049
Mailing Address - Street 1:PSC 78 BOX 2557
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0026
Mailing Address - Country:US
Mailing Address - Phone:316-789-6049
Mailing Address - Fax:
Practice Address - Street 1:14209 E LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-9540
Practice Address - Country:US
Practice Address - Phone:316-789-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty