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NPI Code Detail

MEDICARE: TST MEDICAL, P.A.

MEDICARE: TST MEDICAL, P.A.
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053384859
Entity Type Code : Organization
Provider Name (Legal Business Name) : TST MEDICAL, P.A.
Provider Business Mailing Address
First Line : PO BOX 2448
Second Line :
City : HENDERSONVILLE
State : NC
Zip : 28793-2448
Country : US
Telephone Number : 828-693-4431
Fax Number : 828-693-4871
Provider Business Practice Location Address
First Line : 510 BALSAM RD
Second Line :
City : HENDERSONVILLE
State : NC
Zip : 28792-5703
Country : US
Telephone Number : 828-693-4431
Fax Number : 828-693-4871
Authorized Official
Title or Position : PRACTICE MANAGER
Name : BRANDY L WILSON
Credential :
Telephone Number : 828-693-4431
Provider Enumeration Date : 02/10/2006
Last Update Date : 08/30/2012

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1891772513 — MR. LARRY JOE RUSSELL MD
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