NPIMap

Organization Active NPI

Sikeston Surgical Specialist, LLC

  • Surgery Physician
  • Sikeston, MO
National Provider Identifier
1386058170
Registry record updated Aug 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2009005897 Issued in MO
Legal business name
SIKESTON SURGICAL SPECIALIST, LLC
Practice address
1226 Linn St
Suite B
Sikeston, MO 63801-5200
Phone
(573) 475-8599
Fax
(573) 475-8596
NPI assigned
Jun 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Hollis Tidmore, MD
Title
Owner
Phone
(573) 475-8599

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 2009005897 MO Primary

Addresses

Primary practice location

1226 Linn St
Suite B
Sikeston, MO 63801-5200

Mailing address

1226 Linn St
Suite B
Sikeston, MO 63801-5200

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11992/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1386058170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 LINN ST",
            "address_2": "SUITE B",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 LINN ST",
            "address_2": "SUITE B",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015200",
            "telephone_number": "573-475-8599",
            "fax_number": "573-475-8596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIKESTON SURGICAL SPECIALIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "TIDMORE",
        "authorized_official_first_name": "HOLLIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-475-8599",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MO",
            "license": "2009005897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.