Individual
THOMAS G TYNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3000 ST MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 395-4499
(803) 395-4480
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3012
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000194021
UNISON
SC
01
—
20056087
FIRST CHOICE
SC
01
—
576008010006
BLUE CHOICE
SC
01
—
576008010009
BCBS
SC
01
—
576008010015
TRICARE
SC
01
—
5S867
MEDICAE PART B
LA
05
—
AN1516
—
SC
01
—
MM5083
MEDICARE PART B
ME
Enumeration date
08/14/2006
Last updated
04/28/2008
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