Provider Demographics
NPI:1750341277
Name:TYLER RADIOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:TYLER RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:REUTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-593-2539
Mailing Address - Street 1:627 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1832
Mailing Address - Country:US
Mailing Address - Phone:903-593-2539
Mailing Address - Fax:903-593-0559
Practice Address - Street 1:627 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1832
Practice Address - Country:US
Practice Address - Phone:903-593-2539
Practice Address - Fax:903-593-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112587404Medicaid
TX112587404Medicaid
TX112587404Medicaid