MEDICARE: TRILLIUM FAMILY MEDICINE, PLLC

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	207Q00000X	Family Medicine Physician	184568	NC

General Provider Information

NPI Number	:	1518221829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILLIUM FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 701
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-0701
Country	:	US
Telephone Number	:	828-587-6311
Fax Number	:	828-586-8209

Provider Business Practice Location Address
First Line	:	3 DOCTORS PARK STE A
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4521
Country	:	US
Telephone Number	:	828-772-8673
Fax Number	:	828-586-8209

Authorized Official
Title or Position	:	CREDENTIALING COORDIANTOR
Name	:	RHONDA WILLIAMS
Credential	:
Telephone Number	:	828-339-7257

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	09/08/2020

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