Provider Demographics
NPI:1326102237
Name:AVERA TYLER
Entity Type:Organization
Organization Name:AVERA TYLER
Other - Org Name:AVERA TYLER HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STREIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-9160
Mailing Address - Street 1:240 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-1166
Mailing Address - Country:US
Mailing Address - Phone:507-247-5521
Mailing Address - Fax:507-247-2325
Practice Address - Street 1:240 WILLOW STREET
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178
Practice Address - Country:US
Practice Address - Phone:507-247-5521
Practice Address - Fax:507-247-2325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA MARSHALL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-22
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380347275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN599245100Medicaid
MN1889EALOtherBLUE CROSS
MN24Z348Medicare Oscar/Certification