Basic Information
| Provider Information | |||||||||
| NPI: | 1194951806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRANSYLVANIA COMMUNITY HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BREVARD CANCER AND INFUSION CENTER AT TRANSYLVANIA REGIONAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 HOSPITAL DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287124838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288833987 | ||||||||
| FaxNumber: | 8288848801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT-REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 8286514144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRANSYLVANIA COMMUNITY HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0200X | H0111 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 022CK | 01 | NC | BCBS | OTHER | DN1755 | 01 | NC | RAILROAD MEDICARE PTAN | OTHER | 235114H | 01 | NC | MEDICARE PTAN | OTHER |