Provider Demographics
NPI:1922682244
Name:PREMISE MEDICAL, PLLC
Entity Type:Organization
Organization Name:PREMISE MEDICAL, PLLC
Other - Org Name:PREMISE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-297-5222
Mailing Address - Street 1:3250 W PLEASANT RUN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1069
Mailing Address - Country:US
Mailing Address - Phone:469-297-5222
Mailing Address - Fax:855-651-0605
Practice Address - Street 1:3250 W PLEASANT RUN RD STE 130
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1069
Practice Address - Country:US
Practice Address - Phone:469-297-5222
Practice Address - Fax:855-651-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty