# PREMISE HEALTH OF FLORIDA MEDICAL, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Liberty Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780951509
- **Authorized official:** JON LEIZMAN M.D. (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 10400 S US HIGHWAY 1, PORT SAINT LUCIE, FL 34952-5600
- **Practice address phone:** (772) 398-5651
- **Practice address fax:** (772) 337-4971
- **Mailing address:** 5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/22/2011
- **Last updated:** 08/15/2022