MEDICARE: PREMISE HEALTH OF NEVADA MEDICAL HINITT 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	332900000X	Non-Pharmacy Dispensing Site

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	906	OTHER	NV	STATE MD LICENSE

General Provider Information

NPI Number	:	1811668072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF NEVADA MEDICAL HINITT 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	:	190 W 6TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-4502
Country	:	US
Telephone Number	:	775-328-9220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN ASHLEY HINITT
Credential	:
Telephone Number	:	210-563-5077

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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