Tysen J Petre (NPI# 1871642470, PAC ID# 7719080845) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1871642470 |
| PAC ID by PECOS | 7719080845 |
| Professional Enrollment ID | I20070312000033 |
| Full Name | Tysen J Petre |
| Organization Legal Name | MARINO PHILLIPS AND EARLY CLINIC LLC |
| Address |
1 Crown Dr Suite 200 Kirksville MO 63501-2510 |
| Phone Number | 6606652846 |
| Gender | M |
| Credential | DO |
| Medical School | KIRKSVILLE COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2004 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 6901920099 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 260022 | NORTHEAST REGIONAL MEDICAL CENTER |
| 260200 | SSM ST JOSEPH HOSPITAL WEST |
| 260005 | SSM ST JOSEPH HEALTH CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1 Crown Dr, Suite 200, Kirksville, MO 63501-2510 | 6606652846 | MARINO PHILLIPS AND EARLY CLINIC LLC |
| Organization Legal Name | MARINO PHILLIPS AND EARLY CLINIC LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lylia Jean Poland | Nurse Practitioner | Marino Phillips and Early Clinic LLC | 1 Crown Dr, Suite 200, Kirksville, MO 63501-2510 |
| Street Address |
1 CROWN DR SUITE 200 |
| City | KIRKSVILLE |
| State | MO |
| Zip | 63501-2510 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lylia Jean Poland | Nurse Practitioner | Marino Phillips and Early Clinic LLC | 1 Crown Dr, Suite 200, Kirksville, MO 63501-2510 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John Bailey | Orthopedic Surgery | 1701 N Elson St, Kirksville, MO 63501-1129 | |
| Michelle L Woodward | Qualified Audiologist | Woodward Audiology, LLC | 700 W Jefferson St, Gutensohn Clinic 4th Floor, Kirksville, MO 63501-1441 |
| Mariah Nina Richard | Qualified Audiologist | Woodward Audiology, LLC | 700 W Jefferson St, Gutensohn Clinic 4th Floor, Kirksville, MO 63501-1441 |
| Daniel R Richert | Qualified Audiologist | Woodward Audiology, LLC | 700 W Jefferson St, Gutensohn Clinic 4th Floor, Kirksville, MO 63501-1441 |
| Emily J Finley | Audiologist | Woodward Audiology, LLC | 700 W Jefferson St, Gutensohn Clinic 4th Floor, Kirksville, MO 63501-1441 |
| Ronald Leland Phillips | Family Practice | At Still University of Health Sciences | 800 W Jefferson, Kirksville, MO 63501-1443 |
| Tyler O'neil Eschbach | Physician Assistant | Kirksville Clinic Corp | 800 W Jefferson St, Kirksville, MO 63501-1443 |
| Jessica Kile Caine | General Surgery | Heartland Surgical Specialists LLP | 800 W Jefferson St, Kirksville, MO 63501-1443 |
| Jonathan M Beary | Neurology | Kirksville Clinic Corp | 800 W Jefferson St, Kirksville, MO 63501-1443 |
| Philip S Mcintire | General Surgery | Heartland Surgical Specialists LLP | 800 W Jefferson St, Kirksville, MO 63501-1443 |
| Find all physicians in zip 63501 | |||
| City | KIRKSVILLE |
| Zip Code | 63501 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | KIRKSVILLE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Tysen J Petre.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.