NPIMap

Organization Active NPI

Premise Health of Utah Medical PC

Doing business as Granite Wellness Center

  • Multi-Specialty Clinic/Center
  • West Valley City, UT
National Provider Identifier
1063986800
Registry record updated Jan 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF UTAH MEDICAL PC
Doing business as
Granite Wellness Center
Practice address
4163 S 3200 W
West Valley City, UT 84119-5128
Phone
(801) 964-9355
Fax
(801) 967-2692
NPI assigned
Jan 15, 2019
Last updated
Jan 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edward William Schwartz
Title
President
Phone
(844) 407-7557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

4163 S 3200 W
West Valley City, UT 84119-5128

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Granite Wellness Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2161974Premise Health of Utah Medical, PC4163 South 3200 West, West Valley City, UT 84119Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
3 Form - West Valley City5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4163 S 3200 W
West Valley City, UT 84119
Phone (801) 964-9355

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769644800000",
    "number": "1063986800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4163 S 3200 W",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841195128",
            "telephone_number": "801-964-9355",
            "fax_number": "801-967-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF UTAH MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-15",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "844-407-7557"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granite Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Granite Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.