Provider Demographics
NPI:1275836561
Name:TYLER PROSTHETICS INC
Entity Type:Organization
Organization Name:TYLER PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-316-3171
Mailing Address - Street 1:701 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1834
Mailing Address - Country:US
Mailing Address - Phone:903-595-2600
Mailing Address - Fax:903-595-2604
Practice Address - Street 1:701 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1834
Practice Address - Country:US
Practice Address - Phone:903-595-2600
Practice Address - Fax:903-595-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101350332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies