=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760702930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSYLVANIA PHYSICIAN SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2010
-----------------------------------------------------
Last Update Date | 04/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 MEDICAL PARK DR STE B
-----------------------------------------------------
City | BREVARD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28712-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-884-8860
-----------------------------------------------------
Fax | 828-885-7164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 602373
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-213-1500
-----------------------------------------------------
Fax | 828-651-6570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF REVENUE OFFICER
-----------------------------------------------------
Name | RHONDA A MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-651-4144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------