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NPI Code Detail

MEDICARE: PREMISE HEALTH OF INDIANA MEDICAL PC

MEDICARE: PREMISE HEALTH OF INDIANA 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1235509167
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMISE HEALTH OF INDIANA 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 : 806 JACKSON ST
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-6264
Country : US
Telephone Number : 812-748-3412
Fax Number : 812-748-3413
Authorized Official
Title or Position : PRESIDENT
Name : EDWARD WILLIAM SCHWARTZ
Credential :
Telephone Number : 844-407-7557
Provider Enumeration Date : 10/05/2015
Last Update Date : 02/03/2026

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Directions to “PREMISE HEALTH OF INDIANA MEDICAL PC ” Practice Location

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