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NPI Code Detail

MEDICARE: PREMISE HEALTH OF ILLINOIS MEDICAL PC

MEDICARE: PREMISE HEALTH OF ILLINOIS 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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1194592790
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMISE HEALTH OF ILLINOIS 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 : 320 N MORGAN STREET
Second Line : SUITE 600
City : CHICAGO
State : IL
Zip : 60607-1321
Country : US
Telephone Number : 888-926-9385
Fax Number : 312-229-8817
Authorized Official
Title or Position : PRESIDENT
Name : EDWARD WILLIAM SCHWARTZ
Credential :
Telephone Number : 844-407-7557
Provider Enumeration Date : 12/05/2023
Last Update Date : 02/03/2026

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