| Avera Medical Group Tyler | |
|
240 Willow St Tyler MN 56178-0240 | |
| (507) 247-5921 | |
| (507) 247-5184 |
| Full Name | Avera Medical Group Tyler |
|---|---|
| Speciality | Clinic/Center |
| Location | 240 Willow St, Tyler, 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 Medical Group Tyler 240 Willow St Tyler MN 56178-1201 Ph: (507) 247-5921 | Avera Medical Group Tyler 240 Willow St Tyler MN 56178-0240 Ph: (507) 247-5921 |
| NPI Number | 1649223439 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 12/02/2022 |
| Medicare PECOS PAC ID | 1557252533 |
|---|---|
| Medicare Enrollment ID | O20040320000679 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649223439 | NPI | - | NPPES |
| C07385 | Other | MN | PART B MC |
| 5T014TY | Other | MN | BLUE CROSS BLUE SHIELD |
| 97635800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Marcia S Kells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164498804 PECOS PAC ID: 5092853382 Enrollment ID: I20091106000029 |
| Provider Name | Jessica Joy Moriarty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710207063 PECOS PAC ID: 5698964559 Enrollment ID: I20110106001174 |
| Provider Name | Amy F Nicolas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619231834 PECOS PAC ID: 1153572219 Enrollment ID: I20121119000460 |
| Provider Name | Heidi A Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629414578 PECOS PAC ID: 4385885334 Enrollment ID: I20130802000394 |
| Provider Name | Richard L Klingler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235186230 PECOS PAC ID: 2961620190 Enrollment ID: I20160201000045 |
Tyler Family Dental Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 197 N Tyler St, Tyler, MN 56178 Phone: 507-247-5591 |