Individual ProviderTyson Jaye SamCase Manager/Care CoordinatorOther Service ProvidersPractice Address5608 Zuni Rd SE, Albuquerque, NM 87108-2926(505) 262-6565PECOS EnrollmentBased on the most recent information from CMS, provider Tyson Jaye Sam does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1982937330Provider TypeIndividualFull NameSam, Tyson JayeTitleMr.CredentialAA IN PSYCHOLOGYGenderMaleSole ProprietorYesEnumeration Date9/16/2009Last Updated9/16/2009Contact InformationPractice LocationPractice Address5608 Zuni Rd SE, Albuquerque, NM 87108-2926Phone(505) 262-6565Fax(505) 255-9066Mailing LocationMailing Address5608 Zuni Rd SE, Albuquerque, NM 87108-2926Phone(505) 262-6565Fax(505) 255-9066Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer