Provider Demographics
NPI:1427293869
Name:TYSON RESPIRATORY SERVICES
Entity type:Organization
Organization Name:TYSON RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:336-437-7217
Mailing Address - Street 1:3508 GARDEN RD
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8716
Mailing Address - Country:US
Mailing Address - Phone:336-437-7217
Mailing Address - Fax:877-511-2191
Practice Address - Street 1:3508 GARDEN RD
Practice Address - Street 2:SUITE D-3
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8716
Practice Address - Country:US
Practice Address - Phone:336-437-7217
Practice Address - Fax:877-511-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-4816227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty