MEDICARE: PREMISE HEALTH OF NORTH CAROLINA 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1093042152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF NORTH CAROLINA MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 ELLIS RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-5543
Country	:	US
Telephone Number	:	919-998-2151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN HINITT
Credential	:
Telephone Number	:	844-407-7557

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

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