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Contact Information

HOLLIS TIDMORE, MD
1422 S SAM HOUSTON BLVD
HOUSTON, MO65483-2130
 Phone: 417-967-1252
 Fax: 417-967-0417
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

Trauma Surgery

2086S0127X 02 Physician/General Surgery
 

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for HOLLIS TIDMORE · (Male)

NPI # 1962473975
Status Active
Credentials MD
Entity Individual
Enumeration date 01/28/2006
Last updated 01/31/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2009005897
  • MO Medicaid 207050501
Hospital affiliation(s)
  • MISSOURI DELTA MEDICAL CENTER - (Acute Care)
    1008 NORTH MAIN ST
    SIKESTON, MO 63801
  • TEXAS COUNTY MEMORIAL HOSPITAL - (Acute Care)
    1333 SAM HOUSTON BOULEVARD
    HOUSTON, MO 65483
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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