Basic Information
| Provider Information | |||||||||
| NPI: | 1871548040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANSYLVANIA PHYSICIAN SERVICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BREVARD FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 MEDICAL PARK DR. | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849362 | ||||||||
| FaxNumber: | 8288843815 | ||||||||
| Practice Location | |||||||||
| Address1: | 187 MEDICAL PARK DR. | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849362 | ||||||||
| FaxNumber: | 8288843815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEDNAREK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO TPSI | ||||||||
| AuthorizedOfficialTelephone: | 8288849111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0280W | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 187581 | 01 | NC | MEDCOST | OTHER | 890280W | 05 | NC | MEDICAID |