Provider Demographics
NPI:1225449994
Name:PREMISE HEALTH OF ARIZONA MEDICAL, P.C.
Entity Type:Organization
Organization Name:PREMISE HEALTH OF ARIZONA MEDICAL, P.C.
Other - Org Name:INTEL HEALTH FOR LIFE CENTER CHANDLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
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:SUITE 120
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-468-6242
Mailing Address - Fax:615-468-6242
Practice Address - Street 1:5000 WEST CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3601
Practice Address - Country:US
Practice Address - Phone:480-554-2323
Practice Address - Fax:840-552-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty