Provider Demographics
NPI:1063463446
Name:TRYON FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:TRYON FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIRE-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-3494
Mailing Address - Street 1:2881 NC HWY. 108E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722
Mailing Address - Country:US
Mailing Address - Phone:828-894-3494
Mailing Address - Fax:828-894-5864
Practice Address - Street 1:2881 NC HWY. 108E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722
Practice Address - Country:US
Practice Address - Phone:828-894-3494
Practice Address - Fax:828-894-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011KNMedicaid
NC011KNOtherBCBS
2344563Medicare ID - Type Unspecified