# PREMISE HEALTH OF FLORIDA MEDICAL PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** City of St Cloud
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790459832
- **Authorized official:** JAMES MICHAEL THIEL (PRESIDENT)
- **Authorized official phone:** (844) 407-7557

## Contact information

- **Practice address:** 2950 LAKESHORE BLVD, SAINT CLOUD, FL 34769-1946
- **Practice address phone:** (407) 957-7217
- **Practice address fax:** (508) 885-5400
- **Mailing address:** 5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/03/2021
- **Last updated:** 02/17/2026