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Contact Information

MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
429 ROCKY BAYOU DRIVE
PINEVILLE, LA71360
 Phone: 318-473-9556
 Fax: 318-484-6032
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC

NPI Number 1093262123
LBN Legal business name MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Authorized official MARK DODSON - (BILLING MANAGER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 09/07/2016
Last updated 07/20/2020 - About 6 years ago
Identifiers
LA License # 9317843
LA Medicaid 1946320
LA Other CD7720 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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