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Contact Information

MARTIN S TYSON, DO
1155 W PARKVIEW ST
SUITE 1G
BOLIVAR, MO65613-8279
 Phone: 417-326-8700
 Fax: 417-328-6755
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

Trauma Surgery

2086S0127X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for MARTIN S TYSON · (Male)

NPI # 1851468987
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 11/30/2006
Last updated 12/10/2015 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2001010358
  • MO Medicaid 245315106
  • MO Other 020049033 RAILROAD MEDICARE
  • MO Other 431560263006 TRICARE
Hospital affiliation(s)
  • CITIZENS MEMORIAL HOSPITAL - (Acute Care)
    1500 N OAKLAND
    BOLIVAR, MO 65613
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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