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	:	1790396059
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 120
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W 2ND ST FL 2
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-4019
Country	:	US
Telephone Number	:	205-445-2213
Fax Number	:	205-423-8139

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

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	02/17/2026

Similar Medicare Providers

1689711632 — PLANNED PARENTHOOD SOUTH ATLANTIC
Practice Location Address:

3010 MAPLEWOOD AVE
WINSTON SALEM, NC
27103-4019

Practice Phone: 336-768-2980
Practice Fax: 336-765-6599

1790509073 — LILY ESTELLE MCHUGH WHNP
Practice Location Address:

3010 MAPLEWOOD AVE
WINSTON SALEM, NC
27103-4019

Practice Phone: 336-768-2980
Practice Fax:

1225832942 — AMANDA LYNNE STETZ LMT
Practice Location Address:

31722 WINSTON ST SE
SULTAN, WA
98294-4019

Practice Phone: 425-223-7695
Practice Fax:

1437112885 — JOHN MICHAEL SHOLAR PMHNP
Practice Location Address:

1118 OAK ST SE
SALEM, OR
97301-4019

Practice Phone: 503-585-4949
Practice Fax: 503-585-4965

1447317375 — MS. SHERYL LYNNE WAKELING MA QMHP LPC
Practice Location Address:

1118 OAK ST SE
SALEM, OR
97301-4019

Practice Phone: 503-585-4949
Practice Fax:

1932239852 — MARIO DE OBALDIA JR. MS MFT
Practice Location Address:

1118 OAK ST SE
SALEM, OR
97301-4019

Practice Phone: 503-302-9295
Practice Fax:

Directions to “PREMISE HEALTH OF NORTH CAROLINA MEDICAL PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.