Premise Health

Primary specialty

PharmacyTaxonomy code 333600000X

License

12514 Issued in NC

Legal business name

PREMISE HEALTH

Doing business as

The Living Well Health Center - Tobaccoville

Practice address

7855 Doral Dr
Tobaccoville, NC 27050-9002

Phone

(336) 741-1319

Fax

(336) 714-1803

NPI assigned

Jun 29, 2016

Last updated

Jun 29, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joyce Jensen

Title

Director Site Operations

Phone

(904) 401-1175

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• The Living Well Health Center - Tobaccoville Doing business as

Tax ID family

Premise Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Premise Health

  dba The Living Well Health Center - Downtown Plaza

  • Pharmacy
  • Winston Salem, NC
  • NPI 1023469228
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Emily J Moorefield, RN HEALTH COACH

  • Registered Nurse
  • Tobaccoville, NC
  • NPI 1295574333
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1114378312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SUMMIT SQUARE BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271051485",
            "telephone_number": "336-377-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7855 DORAL DR",
            "city": "TOBACCOVILLE",
            "state": "NC",
            "postal_code": "270509002",
            "telephone_number": "336-741-1319",
            "fax_number": "336-714-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "DIRECTOR SITE OPERATIONS",
        "authorized_official_telephone_number": "904-401-1175"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "12514",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160658",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Living Well Health Center - Tobaccoville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hope4Tomorrowllc
• Stepehn Adrian Hubbard, MD,FACEP
• Individual
• Emily J Moorefield, RN HEALTH COACH
• Ourhealth Professional Physician Group, LLC (Live Well Tobaccoville)
• Premise Health of North Carolina Medical PC (RAI Medical Center)
• Jenifer Knight Shadrick, MA, QP, LPC, LCAS-A

• Pharmacy in Tobaccoville, NC
• Providers in Tobaccoville, NC by specialty
• Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.