NPIMap

Organization Active NPI

Premise Health of Connecticut Medical, P.C.

Doing business as BAE Systems-Manchester

  • Multi-Specialty Clinic/Center
  • Manchester, NH
National Provider Identifier
1982373726
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 CONNECTICUT MEDICAL, P.C.
Doing business as
BAE Systems-Manchester
Practice address
3000 Goffs Falls Rd
Manchester, NH 03103-6109
Phone
(603) 506-0203
Fax
(603) 506-0204
NPI assigned
Sep 7, 2021
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
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

3000 Goffs Falls Rd
Manchester, NH 03103-6109

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 1

  • BAE Systems-Manchester Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Connecticut Medical PC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

3000 Goffs Falls Rd
Manchester, NH 03103
Phone (603) 506-0203

NPI Registry JSON

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1982373726",
    "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": "3000 GOFFS FALLS RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031036109",
            "telephone_number": "603-506-0203",
            "fax_number": "603-506-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-07",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAE Systems-Manchester",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAE Systems-Manchester",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, NH

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.