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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1477881845
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	:	300 E RANDOLPH ST # CL404
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-5099
Country	:	US
Telephone Number	:	312-653-3300
Fax Number	:	312-653-3398

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	02/11/2026

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