Organization
PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
16526 NC HIGHWAY 87 W, TAR HEEL, NC 28392-8608
(910) 872-5710
(910) 872-5711
Mailing address
16526 NC HIGHWAY 87 W, TAR HEEL, NC 28392-8608
(910) 872-5710
(910) 872-5711
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
08321
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08321
NC PHARMACY PERMIT
NC
Enumeration date
01/26/2007
Last updated
08/24/2022
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