PREMISE HEALTH OF OHIO MEDICAL P.A NPI 1447926845

NPI Information

PREMISE HEALTH OF OHIO MEDICAL, P.A is a multi-specialty clinic center in Fort Jennings, OH. PREMISE HEALTH OF OHIO MEDICAL, P.A NPI is 1447926845. The provider is registered as an organization entity type.
The provider Is Doing Business As Midway - Fort Jennings.

The provider's business location address is:

200 PROGRESSIVE DRIVE
FORT JENNINGS, OH
ZIP 45844
Phone: (419) 453-1111

The provider's authorized official is Jonathan B 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 36D1090826 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/17/2021 and was last updated on 8/16/2022.

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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