PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C
NPI 1689457715
Clinic/Center - Multi-Specialty in Hanover Township, PA
About Premise Health Of Pennsylvania Medical, P.c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C (NPI 1689457715), doing business as Adidas Wilkes-barre Health Center, is a healthcare organization registered as a multi-specialty in Hanover Township, Pennsylvania and active in the NPI registry since August 2023. The organization holds a CLIA Waiver certificate valid through October 19, 2027 and lists Jon Leizman, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
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 39D2292144
Premise Health Of Pennsylvania Medical, PC · Wilkes Barre, PAFrequently 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 Pennsylvania Medical, P.C's NPI number?
The NPI number for Premise Health Of Pennsylvania Medical, P.C is 1689457715. It was assigned to this organization in the NPPES registry on August 14, 2023. The provider is doing business as Adidas Wilkes-Barre Health Center.
Where is Premise Health Of Pennsylvania Medical, P.C located?
Premise Health Of Pennsylvania Medical, P.C is located at 550 New Commerce Blvd, Hanover Township, PA 18706. The listed phone number is (615) 468-3188.
What is Premise Health Of Pennsylvania Medical, P.C's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.
Does Premise Health Of Pennsylvania Medical, P.C hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 39D2292144) is associated with this NPI, valid through October 19, 2027. 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 Pennsylvania Medical, P.C was last updated on August 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Premise Health Of Pennsylvania Medical, P.c · NPI 1689457715
Multi-Specialty organization in Hanover Township, Pennsylvania. Organization record, active in the CMS NPPES registry since August 14, 2023.
## Identity
- **NPI:** 1689457715 (Entity type: Organization)
- **Enumerated:** August 14, 2023
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Also known as:** Adidas Wilkes-Barre Health Center (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Jon Leizman, PRESIDENT
## Practice location
- **Address:** 550 NEW COMMERCE BLVD, Hanover Township, PA 18706-1404
- **Phone:** (615) 468-3188
## Record status
- **NPPES last updated:** August 14, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1689457715) · Data from the CMS NPPES public registry.