Healthcare Provider Details

I. General information

NPI: 1356272165
Provider Name (Legal Business Name): PREMISE HEALTH OF MISSOURI MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PINE ST RM 14W-N01
SAINT LOUIS MO
63101-2015
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-0429
  • Fax: 314-433-4116
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WILLIAM SCHWARTZ
Title or Position: PRESIDENT
Credential:
Phone: 844-407-7557