Provider Demographics
NPI:1922005982
Name:TYLER MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:TYLER MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-695-7274
Mailing Address - Street 1:120 W ALLEGHENY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9788
Mailing Address - Country:US
Mailing Address - Phone:724-695-7274
Mailing Address - Fax:724-695-7815
Practice Address - Street 1:120 W ALLEGHENY RD STE 3
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9788
Practice Address - Country:US
Practice Address - Phone:724-695-7274
Practice Address - Fax:724-695-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0743160001Medicare ID - Type Unspecified