Provider Demographics
NPI:1447881487
Name:TYRIAN HEALTHCARE, LLC
Entity type:Organization
Organization Name:TYRIAN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO/ NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOUFIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHAIRALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:309-306-1039
Mailing Address - Street 1:PO BOX 9183
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9183
Mailing Address - Country:US
Mailing Address - Phone:309-306-1039
Mailing Address - Fax:
Practice Address - Street 1:2120 W HEADING AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5138
Practice Address - Country:US
Practice Address - Phone:309-306-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty