MEDICARE: DR. ARCHIE A. TYSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	29432	NC
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	29432	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00654540	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629039862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARCHIE A. TYSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-996-7076
Fax Number	:	336-996-7832

Provider Business Practice Location Address
First Line	:	1226 EASTCHESTER DR STE 100
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-3116
Country	:	US
Telephone Number	:	336-481-8540
Fax Number	:	336-481-8549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	12/10/2020

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Directions to “ DR. ARCHIE A. TYSON M.D.” Practice Location

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