OrganizationPremise Health Of Oklahoma Medical, P.C(Premise Health - Broken Arrow)Clinic/CenterAmbulatory Health Care FacilitiesPractice Address1104 E Kenosha St, Broken Arrow, OK 74012-2067(918) 994-6866PECOS EnrollmentBased on the most recent information from CMS, provider Premise Health Of Oklahoma Medical, P.C does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861972291Provider TypeOrganizationFull NamePremise Health Of Oklahoma Medical, P.COther NamePremise Health - Broken ArrowSubpartNoEnumeration Date8/15/2018Last Updated10/13/2022Contact InformationPractice LocationPractice Address1104 E Kenosha St, Broken Arrow, OK 74012-2067Phone(918) 994-6866Fax(918) 994-6897Mailing LocationMailing Address5500 Maryland Way Ste 400, Brentwood, TN 37027-7048PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameLeizman, Jonathan (President)Phone(216) 479-9063Provider TaxonomiesCodeDescriptionLicenseCode261QP2300XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted Issuer