Provider Demographics
NPI:1265823132
Name:PREMISE HEALTH OF OHIO MEDICAL, P.A
Entity Type:Organization
Organization Name:PREMISE HEALTH OF OHIO MEDICAL, P.A
Other - Org Name:PIXELLE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-479-9063
Mailing Address - Street 1:5500 MARYLAND WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4973
Mailing Address - Country:US
Mailing Address - Phone:615-468-6548
Mailing Address - Fax:615-468-0477
Practice Address - Street 1:311 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3332
Practice Address - Country:US
Practice Address - Phone:740-775-6119
Practice Address - Fax:740-775-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty