MEDICARE: PREMIERE HEALTH AND WELLNESS MEDICAL CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician
3	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2026035A	OTHER	NC	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679992523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE HEALTH AND WELLNESS MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	2609 N DUKE ST
Second Line	:	SUITE 403
City	:	DURHAM
State	:	NC
Zip	:	27704-3048
Country	:	US
Telephone Number	:	919-416-4700
Fax Number	:	919-416-0821

Provider Business Practice Location Address
First Line	:	608 JACKSON ST
Second Line	:	SUITE H
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-2600
Country	:	US
Telephone Number	:	919-416-4700
Fax Number	:	919-416-0821

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	VENUS IDETTE PITTS
Credential	:	MD
Telephone Number	:	919-416-4700

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	08/26/2025

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