Premise Health Of Texas Medical, P.A
Clinic/Center, Multi-Specialty in Irving, TX. Organization (NPI-2).
NPI number1417455346
StatusActive
Last updated in NPPESAug 23, 2022
Details
- NPI
- 1417455346
- Entity type
- Organization (NPI-2)
- Legal business name
- Premise Health Of Texas Medical, P.A
- Organization subpart
- No
- Enumeration date
- Jan 25, 2018
- Certification date
- Aug 23, 2022
- Last updated
- Aug 23, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
Other names
- Live Well At Citi Medical Clinic (Doing Business As)
Practice location
6400 Las Colinas BlvdIrving, TX 75039-2900
Phone 972-655-5000 · Fax 972-655-5517
Mailing address
5500 Maryland Way Ste 120Brentwood, TN 37027-4993
Authorized official
Jon Leizman
President
2164799063
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