# PREMISE HEALTH OF INDIANA MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** USS Family Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316031081
- **Authorized official:** JON LEIZMAN M.D. (PRESIDENT)
- **Authorized official phone:** (615) 468-6270

## Contact information

- **Practice address:** 251 W 84TH DR, MERRILLVILLE, IN 46410-6243
- **Practice address phone:** (219) 756-4343
- **Practice address fax:** (219) 756-4382
- **Mailing address:** 5500 MARYLAND WAY, ATTN: CBO, BRENTWOOD, TN 37027-4948
- **Mailing address phone:** (800) 830-4255
- **Mailing address fax:** (615) 296-0151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 10/29/2024