# PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BAE Systems-Manchester
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982373726
- **Authorized official:** JON LEIZMAN (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 3000 GOFFS FALLS RD, MANCHESTER, NH 03103-6109
- **Practice address phone:** (603) 506-0203
- **Practice address fax:** (603) 506-0204
- **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:** 09/07/2021
- **Last updated:** 08/15/2022