NPIMap

Organization Active NPI

Premise Health of West Virginia Medical, Medical Corporation

Doing business as Live Well at Citi Medical Clinic

  • Multi-Specialty Clinic/Center
  • Florence, KY
National Provider Identifier
1609369024
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF WEST VIRGINIA MEDICAL, MEDICAL CORPORATION
Doing business as
Live Well at Citi Medical Clinic
Practice address
4600 Houston Rd
Florence, KY 41042-4820
Phone
(859) 283-3613
Fax
(859) 283-3721
NPI assigned
Jun 11, 2018
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Dr. Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

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

Addresses

Primary practice location

4600 Houston Rd
Florence, KY 41042-4820

Mailing address

5500 Maryland Way Ste 400
Brentwood, TN 37027-7048

Other names 1

  • Live Well at Citi Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of West Virginia Medical Medical Corporation27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

4600 Houston Rd
Florence, KY 41042
Phone (859) 283-3613

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1609369024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 HOUSTON RD",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410424820",
            "telephone_number": "859-283-3613",
            "fax_number": "859-283-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF WEST VIRGINIA MEDICAL, MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "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",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Well at Citi Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.