Organization
AVERA TYLER
Active
Parent organization
AVERA MEDICAL GROUP TYLER
Other names
Avera Medical Group Lake Benton
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVERA MEDICAL GROUP TYLER
Authorized official
DEBBIE STREIER (CEO)
(507) 537-9160
Entity
Organization
Contact information
Practice address
109 E BENTON ST, LAKE BENTON, MN 56149-1309
(507) 368-4323
(507) 368-4546
Mailing address
109 E BENTON ST, LAKE BENTON, MN 56149-1309
(507) 368-4323
(507) 368-4546
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T014TY
BLUE CROSS BLUE SHIELD
MN
05
—
9732144
—
MN
Enumeration date
05/19/2006
Last updated
12/02/2022
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