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Contact Information

MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
3444 MASONIC DRIVE
ALEXANDRIA, LA71301
 Phone: 318-473-9556
 Fax: 318-441-8339
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

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

NPI # 1104890052
LBN Legal business name MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
Authorized official NAKITA HICKMAN - (CREDENTIALING MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/16/2006
Last updated 03/24/2026 - About 2 months ago
Identifiers
LA Medicaid 1946320
LA Other 0570570001 MEDICARE DME GROUP #
LA Other CD7720 RAILROAD MEDICARE PALMETT
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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