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Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
Active
Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
Active
Other names
Mid-State Orthopaedic & Sports Medicine Center Inc
Organization subpart
No
Provider details
NPI number
Authorized official
NAKITA C HICKMAN (CREDENTIALING MANAGER)
(318) 441-8329
Entity
Organization
Contact information
Practice address
3444 MASONIC DRIVE, ALEXANDRIA, LA 71301
(318) 473-9556
(318) 441-8339
Mailing address
3444 MASONIC DRIVE, ALEXANDRIA, LA 71301
(318) 473-9556
(318) 441-8339
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0570570001
MEDICARE DME GROUP #
LA
05
—
1946320
—
LA
01
—
CD7720
RAILROAD MEDICARE PALMETT
LA
Enumeration date
02/16/2006
Last updated
03/24/2026
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