Provider Demographics
NPI:1578927141
Name:PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Entity Type:Organization
Organization Name:PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Other - Org Name:PREMISE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
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 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 N MINGO RD
Practice Address - Street 2:TURBINE BUILDING MD 4
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-5000
Practice Address - Country:US
Practice Address - Phone:918-292-3253
Practice Address - Fax:918-292-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty