Provider Demographics
NPI:1003981465
Name:TYLER RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:TYLER RADIOLOGY ASSOCIATES
Other - Org Name:EMPHYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-594-3700
Mailing Address - Street 1:3200 TROUP HWY STE 340
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8343
Mailing Address - Country:US
Mailing Address - Phone:903-534-3700
Mailing Address - Fax:
Practice Address - Street 1:3200 TROUP HWY STE 340
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8343
Practice Address - Country:US
Practice Address - Phone:903-534-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK00006916OtherCHAMPUS ID
TXK00006916OtherCHAMPUS ID
TX00E694Medicare ID - Type Unspecified