Provider Demographics
NPI:1598929903
Name:PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Entity Type:Organization
Organization Name:PREMISE HEALTH OF COLORADO MEDICAL, P.C.
Other - Org Name:MICRON FAMILY HEALTH CENTER
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 1:8000 S FEDERAL WAY # MS 1-706
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9632
Mailing Address - Country:US
Mailing Address - Phone:208-368-5656
Mailing Address - Fax:208-368-5607
Practice Address - Street 1:8000 S FEDERAL WAY # MS 1-706
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9632
Practice Address - Country:US
Practice Address - Phone:208-368-5656
Practice Address - Fax:208-368-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care