PREMISE HEALTH OF WEST VIRGINIA MEDICAL MEDICAL CORPORATION NPI 1275203028

NPI Information

PREMISE HEALTH OF WEST VIRGINIA MEDICAL, MEDICAL CORPORATION is a multi-specialty clinic center in Louisville, KY. PREMISE HEALTH OF WEST VIRGINIA MEDICAL, MEDICAL CORPORATION NPI is 1275203028. The provider is registered as an organization entity type.
The provider Is Doing Business As Premise Health Wellness Center - Louisville.

The provider's business location address is:

10000 BROWNSBORO RD STE 7
LOUISVILLE, KY
ZIP 40241-900
Phone: (502) 272-0330
Fax: (502) 272-0332

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 18D2241715 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/14/2021 and was last updated on 8/15/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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