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PREMISE HEALTH OF WASHINGTON MEDICAL, P.C.

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Company Details

Legal Name: PREMISE HEALTH OF WASHINGTON MEDICAL, P.C.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: October 31st 2011
Expiration date: 31 Oct 2025
UBI Number: 603 155 354
Home State: TENNESSEE
Principal Office Street Address: Google Maps Logo 5500 MARYLAND WAY, SUITE 120, BRENTWOOD, TN, 37027-4993, UNITED STATES

Contact Details

E-Mail: LEGAL@PREMISEHEALTH.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Key Officers & Management

Name Role
WILLIAM D. WRIGHT Governing Person
SHANNON FARRINGTON Governing Person
JONATHAN LEIZMAN MD Governing Person

National Provider Identifier

NPI Number:
1215777198
Certification Date:
2024-05-29

Authorized Person:

Name:
JONATHAN LEIZMAN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
4253787843

History

Type Old value New value Date of change
Name change CHS WASHINGTON STATE MEDICAL, P.C. PREMISE HEALTH OF WASHINGTON MEDICAL, P.C. 2022-01-05
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