Healthcare Provider Details

I. General information

NPI: 1376053843
Provider Name (Legal Business Name): TYSON MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 N IMPERIAL AVE STE C
EL CENTRO CA
92243-1607
US

IV. Provider business mailing address

420 SUNFLOWER CT
BRAWLEY CA
92227-3243
US

V. Phone/Fax

Practice location:
  • Phone: 760-592-4351
  • Fax: 760-790-0017
Mailing address:
  • Phone: 760-592-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN TYSON
Title or Position: CEO
Credential: MD
Phone: 760-592-4351