| Avera Tyler | |
|
109 E Benton St Lake Benton MN 56149-1309 | |
| (507) 368-4323 | |
| (507) 368-4546 |
| Full Name | Avera Tyler |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 E Benton St, Lake Benton, Minnesota |
| Authorized Official Name and Position | Debbie Streier (CEO) |
| Authorized Official Contact | 5075379160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera Tyler 109 E Benton St Lake Benton MN 56149-1309 Ph: (507) 368-4323 | Avera Tyler 109 E Benton St Lake Benton MN 56149-1309 Ph: (507) 368-4323 |
| NPI Number | 1003869892 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 12/02/2022 |
| Medicare PECOS PAC ID | 9638088537 |
|---|---|
| Medicare Enrollment ID | O20161129000531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003869892 | NPI | - | NPPES |
| 9732144 | Medicaid | MN | |
| 5T014TY | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |