Provider Demographics
NPI:1851386585
Name:TYSON, H SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:SCOTT
Last Name:TYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2470
Mailing Address - Country:US
Mailing Address - Phone:614-501-7337
Mailing Address - Fax:614-434-2701
Practice Address - Street 1:905 OLD DILEY RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-864-3222
Practice Address - Fax:614-863-7388
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073267T208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131160Medicaid