# PREMISE HEALTH OF LOUISANNA, PROFESSIONAL MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1629132543
- **Authorized official:** JONATHAN LEIZMAN M.D. (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 121 TURKEY LANE, KINDER, LA 70648
- **Practice address phone:** (337) 738-4414
- **Practice address fax:** (337) 738-7444
- **Mailing address:** 5500 MARYLAND WAY STE 200, BRENTWOOD, TN 37027-4973
- **Mailing address phone:** (216) 479-9063

## Taxonomy

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

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 08/15/2022