HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD – NPI #1770868135
Clinic/Center

HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD is an AHC clinic located in MENOMONEE FALLS, WI. NPPES has assigned the NPI number 1770868135 to HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD on October 18, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD” is a dba name, the actual legal business name for this organization is PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QX0100X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Occupational Medicine

The NPI profile was previously updated about 4 years ago on Aug 15, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD below.

NPI Profile for
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.

NPI Number
1770868135
Enumeration Date

(more than 14 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Doing Business As (dba): HARLEY DAVIDSON HEALTH CENTER- PILGRIM ROAD
Primary location
W156 N 9000 RILGRIM RD
MENOMONEE FALLS, WI 53051
Phone: (262) 502-8752 Fax: (262) 502-8756
Mailing address
16906 COLLECTION CENTER DR
CHICAGO, IL 60693-0169
Phone: (262) 502-8752 Fax: (262) 502-8756
Organization Subpart
No
Authorized Official
JON LEIZMAN
PRESIDENT
Phone: (216) 479-9063
Updated
Certification Date
Aug 15, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QX0100X
- Clinic/Center / Occupational Medicine (Primary)
261QU0200X
- Clinic/Center / Urgent Care
261QP2300X
- Clinic/Center / Primary Care

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.