MEDICARE: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C.

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	:	1689373821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C.

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

Provider Business Practice Location Address
First Line	:	7020 KIT CREEK RD
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9761
Country	:	US
Telephone Number	:	984-243-9581
Fax Number	:	919-891-1396

Authorized Official
Title or Position	:	LEGAL COUNSEL
Name	:	WILLIAM WRIGHT
Credential	:
Telephone Number	:	615-577-5893

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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