Provider Demographics
NPI:1497990287
Name:PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Entity Type:Organization
Organization Name:PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Other - Org Name:EL PASO COUNTY EMPLOYEE HEALTH CENTER EAST
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:
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:719-520-7601
Mailing Address - Fax:719-520-7610
Practice Address - Street 1:1675 GARDEN OF THE GODS RD
Practice Address - Street 2:STE 1053
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9444
Practice Address - Country:US
Practice Address - Phone:719-520-7601
Practice Address - Fax:719-520-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care