Organization
AVERA TYLER
Active
Other names
Avera Medical Group Tyler
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE STREIER (CEO)
(507) 537-9160
Entity
Organization
Contact information
Practice address
240 WILLOW ST, TYLER, MN 56178-0240
(507) 247-5921
(507) 247-5184
Mailing address
240 WILLOW ST, TYLER, MN 56178-1201
(507) 247-5921
(507) 247-5184
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
—
97635800
—
MN
01
—
C07385
PART B MC
MN
Enumeration date
05/19/2006
Last updated
12/02/2022
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