NPIMap

Organization Active NPI

Premise Health of Indiana Medical, P.C.

Doing business as CTC Health & Wellness Center

  • Multi-Specialty Clinic/Center
  • Columbus, IN
National Provider Identifier
1417603879
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF INDIANA MEDICAL, P.C.
Doing business as
CTC Health & Wellness Center
Practice address
1900 McKinley Ave # 50060
Columbus, IN 47201-6414
Phone
(812) 377-4782
Fax
(812) 721-0283
NPI assigned
Feb 24, 2022
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 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 NU Primary

Addresses

Primary practice location

1900 McKinley Ave # 50060
Columbus, IN 47201-6414

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • CTC Health & Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Indiana Medical PC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1900 McKinley Ave
#50060
Columbus, IN 47201
Phone (812) 377-4782

NPI Registry JSON

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1417603879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MCKINLEY AVE # 50060",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472016414",
            "telephone_number": "812-377-4782",
            "fax_number": "812-721-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF INDIANA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CTC Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CTC Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.