# PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255487096
- **Authorized official:** DR. JON LEIZMAN (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 16526 NC HIGHWAY 87 W, TAR HEEL, NC 28392-8608
- **Practice address phone:** (910) 872-5710
- **Practice address fax:** (910) 872-5711
- **Mailing address:** 16526 NC HIGHWAY 87 W, TAR HEEL, NC 28392-8608
- **Mailing address phone:** (910) 872-5710
- **Mailing address fax:** (910) 872-5711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 08321 | NC | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 08/24/2022