MEDICARE: PREMISE HEALTH OF VIRGINIA 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	:	1184903296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF VIRGINIA MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 120
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4881 COX RD BLDG 1
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6293
Country	:	US
Telephone Number	:	804-968-2400
Fax Number	:	804-968-2401

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

Provider Enumeration Date	:	08/06/2011
Last Update Date	:	02/03/2026

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