TYSON MEDICAL CLINIC
NPI 1770338410
Clinic/Center - Primary Care in Oxford, MS

Q: What is Tyson Big Tree LLC's NPI number?

The NPI number for Tyson Big Tree LLC is 1770338410. It was assigned to this organization in the NPPES registry on April 17, 2024. The provider is doing business as Tyson Medical Clinic.

Q: What is Tyson Big Tree LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since April 17, 2024CLIA 25D2290146 · Waiver

2159 S LAMAR BLVD, OXFORD, MS 38655(662) 236-2222 Get Directions Write a Review

NPPES record last updated: January 9, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jan 9, 2025, Apr 17, 2024 (2 updates tracked since 2024).

On this page

About Tyson Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYSON MEDICAL CLINIC (NPI 1770338410) is a healthcare organization registered as a primary care in Oxford, Mississippi and active in the NPI registry since April 2024. The organization holds a CLIA Waiver certificate valid through September 20, 2027 and lists Weston Humphreys, Coo, as its authorized official.

NPPES Registry Identity

NPI1770338410

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameTYSON BIG TREE LLC

Location Address2159 S LAMAR BLVDOxford, MS 38655

Mailing Address2159 S Lamar BlvdOxford, MS 38655 · (662) 236-2222

Phone(662) 236-2222

Organization SubpartNo

Authorized OfficialWeston HumphreysCoo · (662) 236-2222

Enumeration DateApril 17, 2024

Last NPPES UpdateJanuary 9, 20252 updates tracked since enumeration

NPPES CertifiedJanuary 9, 2025

✔ NPI 1770338410 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

Also ListedGeneral PracticeTaxonomy 208D00000X

2159 S LAMAR BLVD, Oxford, MS 38655

Open in Google Maps ↗

Other Names 1

Doing Business AsTyson Medical Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2290146

Tyson Big Tree, LLC · Oxford, MS

Active · expires Sep 20, 2027

CLIA Number25D2290146

Laboratory TypePharmacy

Certificate Effective DateSeptember 21, 2025

Certificate Expiration DateSeptember 20, 2027

Laboratory DirectorRobert H. Lomenick

Laboratory Phone(662) 236-2222

Laboratory LocationTyson Big Tree, LLC2159 S Lamar Blvd, Ste B, Oxford, MS 38655

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRENT A SUTHERLAND

Pharmacist