NPIMap

Organization Active NPI

Premise Health of South Carolina Medical, P.C

Doing business as DTNA Occ - Gaffney

  • Multi-Specialty Clinic/Center
  • Gaffney, SC
National Provider Identifier
1144996539
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, P.C
Doing business as
DTNA Occ - Gaffney
Practice address
211 Woodland Rd
Gaffney, SC 29341-1055
Phone
(864) 301-8325
Fax
(864) 489-1949
NPI assigned
Aug 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jon Leizman
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

211 Woodland Rd
Gaffney, SC 29341-1055

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 1

  • DTNA Occ - Gaffney Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of South Carolina Medical PC18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

211 Woodland Rd
Gaffney, SC 29341
Phone (864) 206-8629

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1144996539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 WOODLAND RD",
            "city": "GAFFNEY",
            "state": "SC",
            "postal_code": "293411055",
            "telephone_number": "864-301-8325",
            "fax_number": "864-489-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DTNA Occ - Gaffney",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DTNA Occ - Gaffney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaffney, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.