MEDICARE: DR. TOMAS VYBIRAL 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	36845	NC
2	207R00000X	Internal Medicine Physician	36845	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2184793C	OTHER	NC	MEDICARE OF NC
4	110141502	OTHER	NC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11397	OTHER	NC	CIGNA HMO
3	56689	OTHER	NC	MEDCOST
5	1143921	OTHER	NC	UNITED HEALTHCARE
6	36312	OTHER	NC	CIGNA PPO
7	4339030	OTHER	NC	AETNA
8	85145	OTHER	NC	BCBS OF NC
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	2756176	OTHER	NC	AETNA HMO

General Provider Information

NPI Number	:	1740285824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMAS VYBIRAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-0249
Country	:	US
Telephone Number	:	336-679-4963
Fax Number	:	336-679-2549

Provider Business Practice Location Address
First Line	:	640 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2487
Country	:	US
Telephone Number	:	336-526-7997
Fax Number	:	336-526-3537

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/11/2023

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