MEDICARE: MPP INFUSION CENTER OF TYLER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician
2	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1952812109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MPP INFUSION CENTER OF TYLER LLC

Provider Business Mailing Address
First Line	:	1726 COLE BLVD STE 250
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3262
Country	:	US
Telephone Number	:	720-465-5030
Fax Number	:

Provider Business Practice Location Address
First Line	:	6115 NEW COPELAND RD STE 130
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-6338
Country	:	US
Telephone Number	:	972-598-0000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	SUE ELLEN ROTTURA
Credential	:
Telephone Number	:	561-323-8987

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	12/08/2025

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