MEDICARE: PREMISE HEALTH OF CONNECTICUT 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1396293338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF CONNECTICUT MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 200
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 NORTHAMPTON BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-5513
Country	:	US
Telephone Number	:	757-955-8875
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	03/03/2026

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