1740285824 NPI number — DR. TOMAS VYBIRAL M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740285824 NPI number — DR. TOMAS VYBIRAL M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

VYBIRAL

Provider First Name:

TOMAS

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1740285824

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/11/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 249

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

YADKINVILLE

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27055-0249

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

336-679-4963

Provider Business Mailing Address Fax Number:

336-679-2549

Provider First Line Business Practice Location Address:

640 PARKWOOD MEDICAL PARK

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ELKIN

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28621-2487

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

336-526-7997

Provider Business Practice Location Address Fax Number:

336-526-3537

Provider Enumeration Date:

06/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  36845 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 36845 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 11397 . This is a "CIGNA HMO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 2184793C . This is a "MEDICARE OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 56689 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 110141502 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1143921 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 36312 . This is a "CIGNA PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 4339030 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 85145 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 8985145 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 2756176 . This is a "AETNA HMO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".