Provider Demographics
NPI:1821221748
Name:PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C
Entity Type:Organization
Organization Name:PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C
Other - Org Name:HIGHMARK HEALTH CENTER AT HAND BY TAKE CARE HEALTH SYSTEMS
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:
Authorized Official - Phone:216-479-9063
Mailing Address - Street 1:120 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-3000
Mailing Address - Country:US
Mailing Address - Phone:888-830-0425
Mailing Address - Fax:
Practice Address - Street 1:501/515 PEN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222
Practice Address - Country:US
Practice Address - Phone:888-830-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKE CARE EMPLOYERSOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-26
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care