Basic Information
| Provider Information | |||||||||
| NPI: | 1972988160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANSYLVANIA COMMUNITY HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 603250 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282603250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 HOSPITAL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CLYDE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287210107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284569006 | ||||||||
| FaxNumber: | 8284568199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 10/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | ARLENE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF REVENUE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8286514144 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRANSYLVANIA COMMUNITY HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | NC | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 207Q00000X | NC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | NC | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 261QR1300X | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1972988160 | 05 | NC | MEDICAID | 5580293 | 01 | NC | UNITED HEALTHCARE | OTHER | 02BZC | 01 | NC | BCBS OF NC | OTHER | 1196768 | 01 | NC | GATEWAY HEALTH PLAN | OTHER |