Provider Demographics
NPI:1225465677
Name:PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Entity Type:Organization
Organization Name:PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Other - Org Name:MAXTON OCCUPATIONAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIZMAN
Authorized Official - Suffix:JR
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:910-844-1236
Mailing Address - Fax:910-844-1349
Practice Address - Street 1:2120 NC 71 HIGHWAY NORTH
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-9433
Practice Address - Country:US
Practice Address - Phone:910-844-1236
Practice Address - Fax:910-844-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine