Basic Information
| Provider Information | |||||||||
| NPI: | 1184832891 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TYLER HEALTHCARE CENTER DBA TYLER HEALTHCARE PHARMACY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 240 WILLOW STREET | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561780280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072475521 | ||||||||
| FaxNumber: | 5072472325 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 WILLOW ST. | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072475521 | ||||||||
| FaxNumber: | 5072472325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | ANTONETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HEALTH INFORMATION MANA | ||||||||
| AuthorizedOfficialTelephone: | 5072475521 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RHIT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MN | Y | Hospitals | General Acute Care Hospital |
No ID Information.