Organization
SIKESTON SURGICAL SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOLLIS TIDMORE MD (OWNER)
(573) 475-8599
Entity
Organization
Contact information
Practice address
1226 LINN ST, SUITE B, SIKESTON, MO 63801-5200
(573) 475-8599
(573) 475-8596
Mailing address
1226 LINN ST, SUITE B, SIKESTON, MO 63801-5200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2009005897
MO
Other
Enumeration date
06/19/2014
Last updated
08/15/2014
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