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LIVE WELL AT CITI MEDICAL CLINIC
NPI 1417455346
Clinic/Center - Multi-Specialty in Irving, TX

Active since January 25, 2018CLIA 45D2144599 · Waiver
6400 LAS COLINAS BLVD, IRVING, TX 75039(972) 655-5000(972) 655-5517 Get Directions Write a Review

NPPES record last updated: August 23, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 23, 2022, Jun 30, 2020 (2 updates tracked since 2020).

About Live Well At Citi Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIVE WELL AT CITI MEDICAL CLINIC (NPI 1417455346) is a healthcare organization registered as a multi-specialty in Irving, Texas and active in the NPI registry since January 2018. The organization holds a CLIA Waiver certificate valid through February 19, 2028 and lists Jon Leizman, President, as its authorized official.

NPPES Registry Identity

NPI1417455346
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePREMISE HEALTH OF TEXAS MEDICAL, P.A
Location Address6400 LAS COLINAS BLVDIrving, TX 75039-2900
Mailing Address5500 Maryland Way Ste 120Brentwood, TN 37027-4993
Phone(972) 655-5000
Fax(972) 655-5517
Organization SubpartNo
Authorized OfficialJon LeizmanPresident · (216) 479-9063
Enumeration DateJanuary 25, 2018
Last NPPES UpdateAugust 23, 20222 updates tracked since enumeration
NPPES CertifiedAugust 23, 2022
✔ NPI 1417455346 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
6400 LAS COLINAS BLVD, Irving, TX 75039
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Other Names 1

Doing Business AsLive Well At Citi Medical Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2144599

Premise Health Of Texas Medical, PA · Irving, TX
Active · expires Feb 19, 2028
CLIA Number45D2144599
Laboratory TypePhysician Office
Certificate Effective DateFebruary 20, 2026
Certificate Expiration DateFebruary 19, 2028
Laboratory DirectorJennifer Hansen
Laboratory Phone(972) 655-5000
Laboratory LocationPremise Health Of Texas Medical, PA6460 Las Colinas Blvd 1st Floor, Irving, TX 75039
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Premise Health Of Texas Medical, P.A's NPI number?

The NPI number for Premise Health Of Texas Medical, P.A is 1417455346. It was assigned to this organization in the NPPES registry on January 25, 2018. The provider is doing business as Live Well At Citi Medical Clinic.

Where is Premise Health Of Texas Medical, P.A located?

Premise Health Of Texas Medical, P.A is located at 6400 Las Colinas Blvd, Irving, TX 75039. The listed phone number is (972) 655-5000.

What is Premise Health Of Texas Medical, P.A's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Premise Health Of Texas Medical, P.A hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2144599) is associated with this NPI, valid through February 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Premise Health Of Texas Medical, P.A was last updated on August 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.