MEDICARE: PREMISE HEALTH OF OKLAHOMA MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1093379331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF OKLAHOMA MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 S COMMERCE ST
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-5010
Country	:	US
Telephone Number	:	580-490-9414
Fax Number	:	580-490-9067

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD WILLIAM SCHWARTZ
Credential	:
Telephone Number	:	844-407-7557

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	02/02/2026

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